They mean the work continues, as the re-election of both President Obama and Governor Shumlin sets the stage for the continuation of the healthcare reform efforts currently in motion at both the State and Federal levels.
Perhaps the most intriguing aspect of that work from a community standpoint will be the announcement of Governor Shumlin’s healthcare financing plan which is due to the Vermont Legislature in January of 2013. While it will not become a bill this year, I am certain it will draw significant interest and spark lively debate. “The Hsiao Report” which studied possible improvements to the sustainability of Vermont’s healthcare system speculated at possible funding mechanisms, such as a payroll tax. To date, we have not seen any details on the Governor’s proposal for how Vermont will finance the new healthcare system which is being created, so there is great anticipation for the January report to the Legislature.
Vermont’s efforts to improve our healthcare system, which have been very aligned with the implementation of the Federal Accountable Care Act (ACA), will continue. Many major initiatives are in motion.
Vermont will continue to implement the health insurance exchange, which is a new way for small businesses with less than 50 employees to purchase health insurance. The details of the pricing and costs on the exchange will likely be available in the summer of 2013. Enrollment should begin in the October of 2013 as the exchange prepares to “go live” in January of 2014. There is uncertainty in the business community about the impact of the exchange, and uncertainty can cause anxiety, so I know these employers are anxious to understand the details of the exchange and how it will impact their employees and their businesses.
The creation of the new insurance company which will operate on the exchange will continue. The Vermont Health CO-OP will be a not-for-profit and member owned, as mandated by the ACA. Their website explains that “the Vermont Health CO-OP is not yet licensed as a health insurer but has an application pending with the Vermont Department of Financial Regulation (DFR). The CO-OP intends to satisfy the licensure requirements in 2013.”
Work on the Accountable Care Organization (ACO) will continue. As I’ve discussed previously, NMC has joined the “One Care” ACO proposed to Medicare by Fletcher Allen and Dartmouth. This is a major undertaking designed to reduce the cost of care while improving the quality of care. If approved, it will bring together those tertiary care facilities, community hospitals like NMC, local physicians, and other providers to manage the care of Medicare patients in a more coordinated and efficient manner.
I believe the Green Mountain Care Board and the Vermont Department of Vermont Health Access will hear in December about their application for a State Innovation Model (SIM) grant to develop “a high performance health system in Vermont that is governed by a coherent strategy and, from the patient’s perspective, achieves full coordination and integration of care throughout a person’s lifespan.” Under the grant, Vermont’s payers (Medicaid and Commercial) will test three existing Medicare models: the Shared Savings Accountable Care Organization, Bundled Payments and Pay-for-Performance.
As a not-for-profit community hospital, NMC is actively engaged in these efforts to create a more sustainable healthcare system. We look forward to continuing that work, which includes expanding our pilot efforts to help reduce avoidable non-emergent visits to our Emergency Department to reduce costs to the system by ensuring patients get the care they need in the proper setting such as a primary care office, walk-in clinic, mental health provider, etc. We also look forward to working with our newly elected legislative delegation on healthcare issues.
There are still more questions than answers about the Vermont’s new healthcare system, but the time for answers is at hand. This much is clear. Vermont needs its community hospitals and we fully intend to continue to be an important part of the care delivery system. Most importantly, amidst it all, NMC will never lose focus on providing exceptional healthcare for our community.
-- Jill Berry Bowen, NMC’s Chief Executive Officer