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Al Gobeille Wants A Vote Soon On 'All-Payer' Health Care Payment Reform

The head of the Green Mountain Care Board, Al Gobeille, says it's critical for his board to vote on a new reimbursement plan for health care providers in the near future.

The proposal is known as “all-payer,” and it would reimburse providers based on the quality of their care and not the quantity of their services.

Gobeille says waiting until after the election could jeopardize the future of this approach in Vermont.

The federal government has given its initial approval to this plan, and now the Green Mountain Care Board must decide if Vermont will move forward with it.

Gobeille says the current reimbursement system, which pays providers for every visit, every procedure and every test, is driving up the cost of health care and needs to be replaced with a model that rewards positive health care outcomes.

Gobeille wants the board to vote on this approach by the end of the month.

He says he's concerned that the election of a new governor and a new president could delay the implementation of the plan indefinitely, because the new leaders might not share the strong commitment that the Shumlin and Obama Administrations have to this proposal.

“I think we need to make a decision on whether we think this is a good idea or not, as a board taking into account the public, the patients and the providers, and see if this is something we think we should do,” Gobeille says. “But the reason for the timeliness of this is because of the election."

For several weeks, the board has been holding public hearings on the all-payer model across the state. Gobeille says he remains optimistic that this new approach will reduce the growth rate of health care spending and provide higher quality care for consumers.

“At this point, we've gotten a lot of feedback. We've tried to address it all, but there isn't anything that's made me think that this isn't a good idea at this point,” Gobeille says.

Gobeille admits that persuading the public to accept a new reimbursement model has been made much more difficult by the rocky performance of Vermont Health Connect, the state's health care exchange.

“I certainly think it's had a huge impact. I think it may have even impacted people's basic trust in government. I don't think you can underestimate the impact that it had,” he says. “[But] I can't sit on my hands and not try to move forward on something that many, many providers think could be a good thing for better quality and bending the cost curve just because of Vermont Health Connect."

Paul Harrington is the executive vice president of the Vermont Medical Society, a group that represents doctors in the state. He says many physicians are eager to abandon the current system as soon as possible.

“The issue is going to be, what's in the agreement, and how effectively is it implemented, and how engaged those providing care and those receiving care are in its actual implementation,” Harrington says. “So if we are going to do this, we should do it soon, so we can take the necessary steps for a good implementation."

Dr. Paul Reiss, a Board member of Health First, an organization of independent doctors in Vermont, says that in order for this new reimbursement model to be successful, the Green Mountain Care Board needs to take steps to strengthen Vermont's system of primary care.

“One of the major metrics in this program is access to primary care and the primary care workforce,” Reiss says. “And if we're going to meet those metrics, we're going to have to come up with something substantial for the primary care doctors to want to want to be involved.”

It's possible that the Green Mountain Care Board could vote on the all payer plan by the end of next week.

The plan involves a six-year agreement between the state and the feds. A future Vermont governor can walk away from the plan with six months notice to the federal participants.

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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