Yes.  We have been actively involved in conversations relating to the drafting of the agreement between Vermont and the Federal government to authorize an ‘all-payer model’ for healthcare here in our state. As was announced last month, the Green Mountain Care Board (GMCB, which regulates hospital budgets) and the Governor have signed the agreement and it is now awaiting formal approval at the Federal level.  Now, we are working with state leaders and the Vermont Association of Hospitals and Health Systems to analyze the details in that agreement and project its specific impact on the physicians and providers in our community and on our hospital – as well as to hospitals and providers across Vermont.  We are all in this together.  We hope this will prove to be a very positive step forward towards improved population health, appropriate reimbursement, and sustainable healthcare costs for Vermont. 

Materials from the GMCB explain that, “The All-Payer Model is an Alternative Payment Model, facilitated by an ACO (Accountable Care Organization), that enables the three main payers of health care in Vermont—Medicaid, Medicare, and commercial insurance—to pay for health care differently than through fee-for-service reimbursement under a common structure, initially including hospital and physician services in Medicare and their commercial and Medicaid equivalents; previously in Vermont, the ACO delivery model has been paired only with a payment model that has a fee-for-service foundation. The Agreement envisions a statewide All-Payer Model that aligns and amplifies incentives across all payers to promote participation, by Model’s end, by the majority of providers in the State.”

This complex undertaking has taken two years of negotiation with the Federal Government.  It is encouraging to now move beyond the conceptual stage and have the actual details to analyze.  The All-Payer Model represents the beginning of a significant shift away from fee-for-service to an approach rooted in population health and being paid to keep people healthy.  We will get paid a capitated amount to care for the covered population.  There are many other capitated agreements in other states, and while none are identical to what we are pursuing in Vermont, there is much we can learn from them as we analyze this opportunity.  It is important to understand that the All-Payer Model continues to be a work in progress in Vermont.  A colleague characterized it well the other day, saying of the vote to approve the draft agreement, “It’s not like a full meal has been served.  It is more like all the ingredients have been delivered and now we need to put it all together.”  That is exciting work with great potential, but it is also challenging work and we must do what is best for Vermonters.

There is good news within the agreement for key programs in Vermont.  This agreement allows the continuation of Federal funding for the Vermont Blueprint for Health (which has done great work with certified medical homes in primary care) and SASH – Support and Services at Home (who “coordinate the resources of social service agencies, community health providers and nonprofit housing organizations to support Vermonters who choose to live independently at home.”)  The continuation of these initiatives, whose funding otherwise would have expired, is in itself is a win for Vermonters. Layer on the benefits of shifting our system’s focus to population health, and it is clear that there could be great advantages in a successful All-Payer Model. That being said we must be diligent in understanding the impact to our system.  Much work remains.

As Vermont takes a closer look at population health, significant interest in the RiseVT efforts here in Franklin and Grand Isle Counties is occurring.  NMC and the District Office of the Vermont Department of Health have taken leading roles with our local Community Committee on Healthy Lifestyles in bringing RiseVT to our community, as we believe it is through primary prevention that Vermonters can stay healthier and thrive within a population health system.  Others are seeing our initial success and coming to understand the value of prevention as we do.  It is very exciting to be in discussions of further expanding RiseVT’s efforts locally and in the possibility of it growing to help Vermonters across the state embrace healthier lifestyles.    

Over the next few months, there will be continued analysis and discussion of the All-Payer Model, its impacts, and how best to proceed.  We totally agree we must make healthcare more sustainable all while maintaining exceptional care and providing the resources for prevention.  What can you do?  Join me in embracing a healthier lifestyle – the only way to reduce costs is by preventing chronic disease which is so much about our lifestyle choices. !  Visit www.RiseVT.com to begin your commitment to your personal wellness plan.

— Jill Berry Bowen, NMC’s Chief Executive Officer