While the Legislature next year is likely to focus on a financing plan for a single payer system, the chairman of the Green Mountain Care Board Al Gobeille says "job number one" is bringing the cost of health care much closer to the rate of inflation.
In the middle of January, Gov. Peter Shumlin is scheduled to unveil his long awaited plan to finance a single payer health care system and lawmakers will review the proposal during the session.
But to the Green Mountain Care Board, the group that oversees virtually every aspect of health care in Vermont, there's a far more important issue to deal with - payment reform.
Gobeille says designing a system to replace the current "fee for service" model is the most critical task facing his board.
"We don't stare at the collection part of the equation every day; we are really looking at payment and delivery reform. That's what we do." - Green Mountain Care Board Al Gobeille
"So how we get the system operating closer to inflation, growing at a rate closer to inflation, that has to be priority number one,” said Gobeille. “We don't stare at the collection part of the equation every day; we are really looking at payment and delivery reform. That's what we do."
Gobeille says the "fee for service" model needs to be replaced because it rewards quantity over quality of care. He envisions a new system that bundles payments for health care providers and allows these providers to be reimbursed to keep their patients healthy.
Gobeille thinks it could make a huge difference when patients are released from the hospital and are in need of comprehensive home care services. If it works, Gobeille says hospital readmission rates will be significantly reduced.
"Where I frankly see this having its biggest effect is in transitions of care,” said Gobeille. “Those transitions of care are what we have to make payment reimbursement. We need to make the delivery of money pay for those transitions in a better way."
Gobeille is hoping to have part of the state's health care system shifted over to a new payment reform model by the end of 2015.
"If we could say this is going to be the trend for the next five years, and we're sitting here a year from now and we've gotten that done, I think that that would be a real positive thing for Vermont," Gobeille said.
Gobeille says he's encouraged that there is preliminary evidence that a payment reform system can be successful in delivering better care at a lower cost.
