Participating in Vermont’s Health Care Evolution

Honored to be appointed to two Advisory positions in relation to Vermont’s evolving health care system, I hope to share their workings with my neighbors.

The Green Mountain Care Board Advisory Committee (GMCBAC) is comprised of 41 Vermont residents.  We serve as a public sounding board for the 5 Board Members responsible for planning Vermont’s road map to a health care system that improves health and moderates costs.

The charge of the Medicaid and Exchange Advisory Board (MEAB) is to advise and inform Vermont’s Department of Health Access (DVHA) on policy development and program administration for the state’s Medicaid‐funded programs, and the Vermont Health Benefit Exchange that is being developed.  The Board is comprised of 30 Vermont residents, evenly divided between beneficiaries of Medicaid or Medicaid‐funded programs, individuals, self‐employed individuals, and representatives of small businesses, large employers, insurance carriers, brokers and agents, advocates for consumer organizations, health care professionals and representatives from a broad range of health care professionals.

As the only person to sit on both Advisories, my goal is to facilitate communication between the two groups as well.

Currently Vermont spends approximately 5.3 billion dollars a year on health care, and it does not reach all Vermonters equally.  Both GMCB and DVHA are charged with helping Vermont do a better job; GMCB by creating a path to health care for all Vermonters, DVHA by creating the Health Care Exchange as a step on that path.

Our current “fee for service” system rewards volume over value, often problematic with over diagnosing, over prescribing and over-treatment.  Without knowing the costs of various tests and procedures ordered in the name of preventing malpractice lawsuits, providers do not have the opportunity to weigh options and find the path that leads to the best health outcomes.  With this system, there is no intrinsic need to coordinate care.

GMCB is investigating and evaluating alternative systems including those of other states, other countries, and Vermont’s own IBM.  The focus of 2012 is to review both hospital and insurance rates, and establish pilot projects testing different methods to pay for and improve the quality of health care in Vermont.  These methods include “bundling”, “global budgets” and “population based payments” as well as Accountable Care Organizations.

Bundling is the process of having one fee for all costs associated with a procedure.  Rather than paying each the surgeon, anesthesiologist, hospital, physical therapist, all followup care, etc for their part in a hip replacement, there would be one fee, period.  This would incentivize the group of practitioners to collectively do their best for the patient.

Population Based payment gives a budget to a hospital, for example, for the number of people it serves with outcomes on limited services that must be met.  The hospital can then manage its funds accordingly.

GMBC is poised to submit a State Innovation Model grant application next month for federal funds to implement and test some of the above stated methodologies.

The hospital budget review process typically evaluates how much money was spent providing health care the previous year and projects into the next.  The GMCB goal is to ask, instead, how can better health care be provided next year?  This year a 3.75% targes was set to signal the need to moderate cost.

GMCB’s new Hospital Budget Review publication is available for download at    GMCB is seeking public comment until 31 August.  PLEASE check it out, add your comments, concerns or ask your questions.  Alternatively, email , GMCB Administrative Assistant.

GMCB is also working to establish Essential Health Benefits (EHB), per the federal Affordable Card Act, that will be universally available to all Vermonters once the Exchange is in place.  DVHA is making recommendations regarding EHB that include hospitalization, Maternity & Newborn Care, Mental Health, prescription drugs, etc.

The full focus of GMCB, DVHA with the assistance of GMCBAC, MEAB and others, is to assist Vermont in developing a culture of care by moderating cost and improving health.  It is a balancing act between making quality health care available to each Vermonter, and paying providers fairly.  It is also a process of changing our collective vision to focus on positive health outcomes rather than procedures performed or drugs prescribed.

My intention is to write periodic updates regarding Vermont’s Health Care evolution through these two groups.  Feel free to contact me with questions in between:

Explore posts in the same categories: H.202 Vermont, Vermont Health Care

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6 Comments on “Participating in Vermont’s Health Care Evolution”

  1. Bette Crawford Says:

    Thank You Julie again for being there for us and myself ! you do know how to get it done !

  2. Says:

    Great work, Julie! Thanks.

    Mary Ann

  3. Karen Kane Says:

    Fantastic, Julie! Did you see Atul Guande’s article in last week’s New Yorker? Stunning. Wishing you all the best!

  4. Witt Liz & Ralph Says:


  5. Awesome job Julie, Thanks for updating us and taking the time to meet the needs with this ever changing subject which impacts all of us.

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