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Explore our coverage of government and politics.

Board Approves 'All-Payer' Model As First Step In Health Care Overhaul

The Green Mountain Care Board on Wednesday approved a plan that will dramatically change how health care providers are reimbursed in Vermont.

The proposal is known as "all-payer" and its goal is to reward providers for positive health care outcomes and to improve the quality of care for many patients.

The unanimous vote by the Green Mountain Care Board is the first step in a multi-year process that's designed to improve the quality of care and reduce the growth rate of health care expenditures.

GMCB chairman Al Gobeille says the current "fee for service" system — one that reimburses providers for every procedure and every test — is driving costs up and is hurting the quality of care.

"I think there is large agreement in this country that ‘fee for service’ medicine is basically something that we need to move away from,” he says. “And second, that coordinated care is better than uncoordinated care.”

Gobeille thinks implementing a system that allows providers to be reimbursed to keep their patients healthy will help contain overall costs.

Eighty-five percent of all health care expenditures are spent on patients with chronic illnesses. Gobeille believes the new payment system could have a big impact on these patients.

"I think it's worth it to try,” he says. “We've tried to do it through regulation with some success, but I think that changing the way providers are paid, changing the incentives in health care is going to get at that in a more meaningful way without hurting quality."  

Some groups urged the board to delay its vote until more details are released about the reimbursement system.

But Gobeille says the vote is just the start of the payment reform process and that it will take a year or two to work through the specifics of the plan.

“I think that as we go through the next couple of years there will actually be calls to make this go faster,” he says. “We're basically going to take between now and Jan. 1, 2018 and work on all of the agreements that need to happen between health insurers and payers and providers and make the changes in the system that are called for."

Gobeille says the all-payer plan will be terminated if health care providers or the private health insurance companies reject the new payment model.

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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