The Green Mountain Care Board has approved a proposal that it hopes will revolutionize how health care providers are reimbursed in Vermont.
The goal is to make health care spending more sustainable by placing a greater emphasis on preventive care and wellness programs.
Health care officials are pursuing this payment reform plan because they don't believe the current "fee for service" system — one that reimburses providers for every test and procedure — is an efficient way to keep patients healthy.
Green Mountain Care Board chairman Kevin Mullin views his panel's unanimous vote as a significant move to control future health care costs.
"This is a major step in what we hope will be a transformation of the health care system in Vermont,” said Mullin.
The Board has approved a $620 million budget for OneCare, an accountable care organization, that has roughly 120,000 patients in Vermont — or about 20 percent of the state's population.
Basically, OneCare is saying that it can provide these patients with all of their health care needs during 2018 for a total of $600 million. The additional money will be used for operational expenses and for funding several small pilot programs.
"This is a major step in what we hope will be a transformation of the health care system in Vermont." — Green Mountain Care Board chairman Kevin Mullin
Mullin says this approach represents a major change in how providers are paid.
"Create a system where prevention and wellness and overall health is put at the top burner and providers will be able to practice in a way that just doesn't reimburse them based on how many procedures and tests and things like that that they do,” said Mullin.
Mike Fisher is Vermont's Health Care Advocate. He wants to be certain that there are procedures in place to ensure that patients are getting the care that they need.
"Making sure that there's adequate transparency, patient protections, and really the kind of quality measures in place so that we can evaluate this project and make sure that it really does result in better care for Vermonters,” said Fisher.
"Making sure that there's adequate transparency, patient protections, and really the kind of quality measures in place so that we can evaluate this project and make sure that it really does result in better care for Vermonters." — Vermont Health Care Advocate Mike Fisher
Green Mountain Care Board Chairman Mullin thinks Fisher is raising an important concern.
"One of the things that we're trying to make sure of is that they don't try to do anything that would actually make the care worse in an attempt to try to achieve savings,” said Mullin. “So there's quality measures and metrics that they have to meet as well."
Mullin says OneCare will benefit from any additional savings in the system but it will also be at financial risk if expenses come in over budget.
