Flood, Wasserman, Hage & Snell: Changing Direction for Vermont Health Care Reform

Flood, Wasserman, Hage & Snell: Changing Direction for Vermont Health Care Reform

This commentary is from Patrick Flood, former commissioner of the Department of Mental Health and the Department of Disabilities, Aging and Independent Living; Julie Wasserman, an independent health policy consultant who has worked for the Vermont state government for more than 25 years; Mark Hage, Director of Benefit Programs at Vermont-NEA; and Deb Snell, staff nurse in the medical intensive care unit at UVM Medical Center and president of the American Federation of Teachers-Vermont and the Vermont Federation of Nurses and Health Professionals, Local 5221.

The Green Mountain Care Board recently testified before the Legislature and called for a major change in how Vermont should pursue health care reform.

There are three main components:

  1. Design and implement “global budgets” for hospitals.
  2. Invest in community medical services that keep Vermonters healthy, productive and out of hospital, such as primary care, nursing, mental health and home care.
  3. Talk to Vermonters about what they want from their health care system and how the proposed reforms should happen.

Proponents have been calling for these changes and more for years, but the state stubbornly sticks to its model of organizing care responsibly, even as it has failed to cut costs, increase access or to significantly improve the quality of care.

Why the change? Perhaps the state has finally accepted that the organization responsible for care cannot accomplish what Vermonters and our health care system really need. This is acknowledged in recent comments to a joint legislative committee by longtime Green Mountain Care Board member Jessica Holmes.

“We are not on a sustainable path,” she said. Then, more specifically:

“But the Vermonters are not winning right now. Health care is not affordable for many families. Many Vermonters lack access to primary care, dental care and other essential services. Our mental health care system falls far short of meeting the needs of Vermonters, and the stories we hear about people’s struggles to find care are truly heartbreaking.

And: “It is essential that this payment reform be done in parallel with a patient-centric, community-centered and provider-inclusive redesign of our health care delivery system.

Kevin Mullin, chairman of the Green Mountain Care Board, also testified in support of this new direction, asking the Legislature for $5 million to implement the proposed changes and to conduct a public dialogue and review process. planning.

Recently, on behalf of a coalition of organizations in Vermont who oppose the accountable care organization model, we met with leaders of the federal agency that oversees our “all-payers model” agreement. We highlighted the coalition’s support for fundamental changes in Vermont’s health care planning, delivery and funding.

Our initial goal was to advocate against renewing the model agreement for all payers. But after the Green Mountain Care Board unveiled the terms and conditions of its new reform plan, we chose instead to voice our support for the board’s latest initiatives provided any changes are anchored on the goals of universal access, d affordability, equity, public accountability, and quality care.

The next stage of reform should prioritize the following:

  • Global hospital budgeting is a structural necessity. Simply put, block budgets are fixed annual payments to hospitals to cover verifiable operating costs and make those costs predictable and sustainable. Hospitals, if assured of sufficient funding for their needs, will not have to charge for each procedure and thus can save money on administrative expenses. And with global budgets, hospitals can be creative and more flexible to help patients in ways that current funding streams make impossible or too complicated. However, global budgets must not be designed to unfairly cap funding or cut vital services. In addition, comprehensive hospital budgeting will require a reorganization of current spending and billing practices deemed excessive and inefficient, so that they are not “integrated” into future budgets.
  • Global budgeting and other reforms mean there is no compelling reason to continue the model of organizing responsible care with public funds beyond 2023. That money is being invested more wisely in the delivery and improvement of care at the local level.
  • The state should oversee and regulate a system of comprehensive hospital budgeting and improved community care delivery with regular contributions from providers, patients, employers and advocacy organizations, thereby ensuring a greater level of accountability public.
  • Workforce issues need to be addressed, starting with the critical shortage of primary care physicians, physician assistants, nurses and nurse aides, and mental health professionals. For too long the state, health care administrators, and the organization responsible for care have failed to tackle this problem head-on, and much of the health care system is now in a hopeless situation. The good news is that there are proven recruitment and retention solutions, including competitive salaries and benefits, debt reduction programs and better working conditions.
  • Major investments in community care – primary and preventative, nurse-led, home care and mental health – are critically important to prevent or intervene early in the event of health problems to avoid unnecessary suffering and more expensive care. It’s common sense. And yet, for too long, our healthcare leaders have focused primarily on our hospitals at the expense of community services.
  • One of the most pressing issues is the deterioration of our mental health system, and this needs to be addressed. A huge percentage of physical health problems are caused or exacerbated by mental health issues and trauma. Right now, our community capacity is so compromised that we are denying access to services and supports that keep people out of crisis and reduce costs.
  • It is critical that the Green Mountain Care Board works closely with local communities and advocacy organizations to design and implement its new reform initiatives.

There will be a lot of resistance against this new direction from the powerful forces vested in the status quo. But maintaining the status quo for the past five years, while masquerading as “payments reform,” has done nothing to improve access to care or reduce costs for Vermonters.

The new leadership of the Green Mountain Care Board can accomplish much of this by redirecting funds from costly and avoidable care to prevention and early intervention. Savings from this systemic change can be used to expand essential services and further reduce costs.

We agree with Ms. Holmes: It’s time for Vermonters to start “winning” on health care reform. Let’s get to work.