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Vermont Legislature
Follow VPR's statehouse coverage, featuring Pete Hirschfeld and Bob Kinzel in our Statehouse Bureau in Montpelier.

Paying For Health Outcomes Is Focus Of New Reform System

State officials have announced a plan that they hope will control health care costs in the future by redesigning how providers are paid.

The goal of this new approach is to encourage providers to work together on a patient’s total health care needs and to improve medical outcomes by allowing the providers to be reimbursed for preventive care.

"We also need to find ways to spend less money for better outcomes. And that is what this is all about" - Gov. Peter Shumlin

State officials are optimistic that if these changes are made, it will significantly slow down the growth rate of health care expenses.

The program will initially create what are known as accountable care organizations for two groups of Vermonters – people enrolled in Medicaid and individuals who get their coverage through the state’s new health care exchange.

Gov. Peter Shumlin says this payment reform system is a critical piece of his overall health care vision for the state.

“We also need to find ways to spend less money for better outcomes and that’s what this is all about. The system right now rewards quantity of care,” Shumlin said. “What we want to move to in Vermont is a system that rewards quality of care, and that’s exactly what we’re launching here today.”

Todd Moore is the head of One Care Vermont. It’s an accountable care organization that’s changing the way that Medicare patients in Vermont receive services.

One Care is developing new payment options with hospitals, community health centers and health care providers. Moore says creating a comprehensive payment approach is good for patients and should improve medical outcomes. 

“The spirit of this is to provide a health care delivery system that’s coordinated around the needs of a patient and communicating with them as a whole person, rather than a series of bits and parts that they might touch if they’re ill," Moore said. "And that’s essential to this revolution as anything.”

Al Gobeille is the chairman of the Green Mountain Care Board. He thinks health care providers will embrace the new payment reform system because they’ll be able to receive some of the savings from the change.

"The name of the game is collaboration. We have to learn to cooperate better, coordinate care better and reduce the gaps in care." - Dr. Paul Reiss, primary care physician

“Shared savings is basically if a provider throughout the course of a year uses less dollars to care for a patient, they share in the savings of what would have been spent based on a trend,” said Gobeille.

Dr. Paul Reiss is a primary care physician in Williston. He’s been working with a group of independent doctors that use this treatment approach with their Medicare patients. He thinks there’s a lot of promise with this option.  

“The name of the game is collaboration. We have to learn to cooperate better, coordinate care better and reduce the gaps in care,” said Reiss. “We know that people are not getting often times proven preventive care that will help them be healthier.”

State officials say it will take several years to gather enough data to evaluate if the new payment reform approach has reduced health care costs.

Bob Kinzel has been covering the Vermont Statehouse since 1981 — longer than any continuously serving member of the Legislature. With his wealth of institutional knowledge, he answers your questions on our series, "Ask Bob."
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