Archive for the ‘H.202 Vermont’ category

Participating in Vermont’s Health Care Evolution

August 13, 2012

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:


H.202 Signing

June 15, 2011


Governor Shumlin signing VT H.202 into Law

26 May 2011 – Comments by Julie Lineberger

Vermont, once again, is leading the nation with its tradition of independent thinking.  We have done this many times including being the first state in the nation to ban slavery, to incorporate universal education, to enact Civil Unions, to make marriage equality law without a judicial order. We are also one of the first states in the nation to allow businesses to incorporate with a charter of social responsibility as a For Benefit Corporation. And now this!

Truly, this is more than just a health care law; it is economic development for the state of Vermont.  With an equal playing field, Vermont businesses can compete in the Global Marketplace.  When our businesses no longer spend 15% – 30% of payroll on health insurance, they can invest in more Vermont employees and higher wages.

Vermont also leads the nation with a very special business organization that believes our success is measured not only in dollars, but also in how we treat our employees, how we interact with our communities and how lightly we walk on this earth.  With over 1200 business members, Vermont Businesses for Social Responsibility represents approximately 15% of Vermont’s workforce.  We are the largest, most active Businesses for Social Responsibility in the United States, leading the way for others.  As VBSR Board Chair, I am honored to be speaking here today.

For 20 years VBSR has worked to decouple health insurance from paychecks. Who decided that only those people working for companies that can afford health insurance are worthy of health care?

This law about to be signed is the culmination of many peoples efforts.  It is an example of how governmental bodies, non-profit organizations and, leading the pack, business owners can work together to affect positive outcomes.  Our nimble State of Vermont takes action where other States waffle.

Thank you, Governor Shumlin for your vision, foresight and commitment.  Thank you Dr. Deb Richter for your tireless effort and coming to Vermont where one person can make a difference. Thank you to all House Committee members who worked for balance and to bring this to the floor under the exceptional leadership of Mark Larson.  Thank you Senator Claire Ayer of the Senate Health and Welfare Committee for leadership in bringing this to the floor for a vote. Thank you House Representatives and your Speaker, Shap Smith for starting the ball rolling.  Thank you State Senators and President Pro Tem John Campbell for guidance through the Senate.

This business community applauds you.  The nation is watching you!  With this law, you sure have your work cut out for you, and those here are willing to roll up our sleeves and help!