Transcript Vermont Health Care Reform of 2006

Health Care Reform in Vermont
NAHSP Presentation
New Orleans
October 6, 2010
Richard Slusky, Director of Payment Reform
Health Care Reform Division
Department of Vermont Health Access
Universal Health Insurance:
It’s Time Has Come
Source: Editorial – New England Journal of Medicine (NEJM)
January 12, 1989, Arnold S. Relman, MD

Promote adequate coverage for all Americans, regardless of
income or employment

Plan Options
1. Qualified Managed Care Health Plans that would compete for
contracts with employers or State-level “public sponsors”
or
2. National Health Program—single public insurance system that
would pay all health care costs from a common pool . . . .with the
recommendation that the Federal government should ultimately
assume total responsibility.
2
Vermont Health Care Reform
60+ Initiatives
Increase Coverage
Improve Quality
• New Coverage Options
– Green Mountain Care
• Premium/Prescription Assistance
• Integrated Marketing and Outreach
• Provider Access
• Promote Wellness / Prevention
• Blueprint for Health
• Health Information Technology
• Quality Transparency
• Accountable Care Organizations
Contain Cost Growth
All of Above PLUS
• Cost Transparency
• Statewide Health Resource Planning and Review
• Prescription Drug Cost Containment
• Administration Simplification
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Commonwealth Fund
State Scorecard 2009
Vermont Rankings

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
Overall
Access
Prevention and Treatment
Avoidable Hospital Use and Cost
Equity
Healthy Lives
1
13
3
11
2
8
Source: The Commonwealth Fund State Scorecard 2009
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Vermont’s Health Care Expenditures
Continue to Rise at an Unsustainable Rate
 Total health care expenditures for Vermont residents are expected
to reach $4.9 billion in 2009 and $5.9 billion by 2012. This results in
an average annual increase of 6.5%.
 Average annual increase in Vermont per capita health care
expenditures over 2009-2012 is projected to be 6.3%. National per
capita health care spending is projected to grow at an average rate
of 4.8% during the same period.
 From 2004 to 2008, Vermont per capita health care expenditures
grew at an average annual rate of 8% compared to 5% for the U.S.
“Some of the variance may be explained by differences in reporting,
including sources of data, definitions, methodologies, timing and
adjustments.”
Source: State of Vermont, Department of Banking, Insurance, Securities and Health
Care Administration, 1/15/2010
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Care Delivery Goals of
Health Care Reform in Vermont
 Vermont’s PCPs will be adequately compensated and
administrative burdens lessened.
 Care will be organized and delivered in a patient-centered
manner through community-based systems (Blueprint for
Health and possible ACOs)
 Rate of growth of health care costs must be slowed or
reduced below current amounts
•
•
•
•
More availability of PCPs (including mid-level providers)
Simplify reimbursement
Reduce administrative costs
Align provider reimbursement with best practices and outcomes
rather than volume
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Cost Control Mechanisms within
Health Care Reform in Vermont
 Certificate of Need Process for new health care projects
 Hospital budget caps
 Insurance carrier rate review
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Vermont Blueprint for Health
 A foundation of medical homes and community health teams that
can support coordinated care and linkages with a broad range of
services
• Supported by insurance companies
 Multi-insurer Payment Reform that supports a foundation of medical
homes and community health teams
• Medicaid, BCBS of Vermont, MVP, CIGNA, State of Vermont
 A health information infrastructure that includes EMRs, hospital data
sources, a health information exchange network, and a centralized
registry
• VITL, GE, Docsite
 An evaluation infrastructure that uses routinely collected data to
support services, guide quality improvement, and determine
program impact
• NCQA Standards, Hospital Admissions, ED Visits
7/21/2015
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Vermont Blueprint for Health
Hospitals
Medical Home
PCPs
Specialty Care & Disease
Management Programs
Community Health Team
Social, Economic, &
Community Services
Mental Health &
Substance Abuse
Programs
Nurse Coordinator
Social Workers
Nutrition Specialists
Community Health Workers
MCAID Care Coordinators
Public Health Specialist
Medical Home
PCPs
Medical Home
PCPs
(Serves @ 20,000 people)
Medical Home
PCPs
Healthier Living
Workshops
Public Health
Programs & Services
7/21/2015
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Vermont Blueprint for Health
Multi-insurer Payment Reforms
Insurers
•Fee for Service
•Unchanged
•Allows competition
•Promotes volume
+
•Patient Centered Medical Home
•Payment to practices
•Consistent across insurers
•Promotes quality
•Based on NCQA Score
•$1.20 - $2.49 PPPM
•Based on active case load
+
•Community Health Teams
•Shared costs as core resource
•Consistent across insurers
•Minimizes barriers
•5 FTE / 20,000 people
•$ 350,000 per 5 FTE
•Scaled based on population
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Blueprint will be expanded to cover
entire Vermont population in 5 years
 Blueprint must include:
• Model for uniform payment by all payors that encourages
medical homes and community health teams
• Creation of a statewide infrastructure of Health Information
Technology
• All insurers required to participate in the Blueprint
• Policies must be consistent with Federal legislation and
requirements for waivers, pilots, etc.
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2010 Events in Vermont
Health Care Reform
 Act 128, Passed by Legislature in Spring 2010
• Increase Coverage
“Ensure universal access to add coverage for essential health
services for all Vermonters . . . .”
• Improve Quality
Vermont’s health delivery system must model continuous
improvement of health care quality and safety . . . and must be
evaluated for improvement in access, quality . . . and reduction in
costs.”
• Contain Cost Growth
A system for containing all system costs and eliminating
unnecessary expenditures . . must be implemented . . . THE
FINANCING OF HEALTH CARE IN VERMONT MUST BE
SUFFICIENT, FAIR, SUSTAINABLE, AND SHARED EQUITABLY.
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2010 Events in Vermont
Health Care Reform (Cont’d)

Act 191 of 2006 created a Commission on Health Care
Reform that includes 4 House Members, 4 Senate Members,
and 2 appointed non-voting members with experience in
health care.
•
Act 128 of 2010: The Commission will engage a consultant to
propose to the legislature, by February 1, 2011, at least 3
design options for creating “a single system on health care
which ensures all Vermonters have access to and coverage for
affordable, quality health services.”
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2010 Events in Vermont
Health Care Reform (Cont’d)
•
Required Design options are:
1. Government-administered and publicly financed “singlepayer” health benefits system, decoupled from employment
and allowing private insurance coverage only for
supplemental health services.
2. Public health benefit system administered by state
government, allowing individuals to choose between the
public options and private insurance coverage.
3. Another option to be determined in consultation with the
Commission.
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Act 128 also created the position of
“Director of Payment Reform”
 The Director of Payment Reform shall oversee the
development, implementation, and evaluation of payment
reform pilot projects:
• Organized around PCPs
• Align with the Blueprint Strategic Plan and Statewide HIT
Technology Plan
• Care should be coordinated
• All payors should reimburse health care providers and
professionals for coordinating patient care through a single
system of payments . . .
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Act 128 also created the position of
“Director of Payment Reform” (Cont’d)
• Medicare should be encouraged to participate in the payment
reform initiatives (pilots should be aligned with Federal law)
• A global budget should be developed
• All insurers in Vermont will be encouraged, if not required, to
participate in the pilot projects
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Summary
• Vermont committed to improve access and quality, and to
reduce costs
Legislative Reform Commission
Consultant’s Report 2/1/2011 to propose at least three
system design options
Director of Payment Reform Report 2/1/2011 to propose
comprehensive payment reform options and pilot projects
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