NMC Commentary

Is RiseVT Key to Working Effectively in a Capitated System and ‘Keeping Patients Healthy’?

Yes.  At a press conference earlier this month, Governor Scott spoke of Vermont’s continued pursuit of the ‘All Payer Model’ to shift our healthcare system away from traditional ‘fee-for-service’ (where providers are paid each time they see a patient) to a population health based approach, where providers are reimbursed to manage and improve the health of their attributed population.  This creates a renewed focus on care coordination among providers and the strong engagement of the patient in their own care.  It also creates a renewed focus on ‘keeping patients healthy’ through primary prevention (keeping healthy people healthy and helping the healthy choice be the easy choice to help prevent the onset of illness or chronic conditions) and ‘secondary prevention’ (working with those who have chronic conditions to better manage their care, so as to avoid the need for costly medical intervention).  The national Prevention Institute says that research shows “for every dollar we spend on prevention, we see a five-to-one return on investment in just five years.” They go so far as to say, “we simply can’t fix our economy without it.”  This shift in focus away from ‘fee-for-service’ and to ‘population health’ is the right direction for Vermont’s healthcare system and we must continue with the hard work of making that transition.

Northwestern Medical Center has agreed to work with the Accountable Care Organizations; participating primary care providers in the region; the University of Vermont Medical Center, Porter Medical Center, and Central Vermont Medical Center on a pilot involving the care of 30,000 patients with Medicaid.  There is financial risk involved, for if the pilot is successful and proper care management and prevention efforts result in the need for care at a cost level below projections, there will be shared savings (up to a capped amount).  However, if it is not successful and the cost of the necessary care exceeds projections, hospitals will have to absorb that excess cost without reimbursement (up to a capped amount).  NMC agreed to participate in the pilot because we strongly believe that enhanced care management and an engaging approach to prevention are true healthcare reform in action. We are committed to working with our patients and our community to reduce duplication, increase integration, pursue prevention, and bend the cost curve.

Does the above description of primary prevention efforts sound familiar?  Does it remind you of the RiseVT movement in our region – our community campaign to embrace healthy lifestyles, improve the quality of life, and reduce healthcare costs where we live, work, learn, and play?  Absolutely.  In fact, there is a statewide stakeholders group currently working to create a path for RiseVT to be replicated in a sustainable manner across Vermont.  The initial success and promising possibilities of RiseVT have caught the eye of decision makers.  It is exciting to be working with Eileen Whalen, COO of University of Vermont Medical Center; Don George, CEO of Blue Cross Blue Shield;  Tracy Dolan, Deputy Commissioner of the Department of Health; Todd Moore, the CEO of OneCare Vermont Accountable Care Organization; Aly Richards, CEO of the Permanent Fund; and other colleagues to explore how all of Vermont can benefit from the positive power of prevention through RiseVT.

We are hopeful that the Administration will recognize the benefits of primary prevention and carry forward the Green Mountain Care Board’s prior enthusiasm for the RiseVT movement.  There are ‘Transformational Funds’ available within the All Payer Model that bring Federal matches to investments in key areas.  While we understand the budget situation in Vermont, we also understand the words of the Prevention Institute regarding the strategic financial importance of investing in prevention.  We are hopeful that the Administration will opt to designate funding as planned within the All Payer waiver application for “Transformational” investments – and that these dollars and their Federal match will help fund the expansion of RiseVT across the state.

Two years ago, we named it RiseVT for a reason.  We believe all of Vermont will benefit from embracing healthier lifestyles and taking active steps to improve our wellness and prevent illness so as to enjoy better quality of life and long-term, lower healthcare costs.  There is a “Transformational” opportunity at hand to advance this effort.  We hope the Administration will agree and help us truly shift the focus of Vermont’s healthcare system to keeping patients – and all Vermonters – healthy.

— Jill Berry Bowen, NMC’s Chief Executive Officer