Lawrence Miller, the governor’s chief of health care reform, and Al Gobeille, chairman of the Green Mountain Care Board, have been in the middle of the state’s talks with officials in the federal Centers for Medicare and Medicaid Services about creating what is called an “all-payer model.” Members of two legislative committees grilled the pair this week about this next big health reform, which the Shumlin administration wants to undertake.
“This is being put forward as a positive step,” Senate Appropriations Chairwoman Jane Kitchel (D-Caledonia) said Wednesday. But despite a lengthy briefing Tuesday, she said, “We are still not clear what the benefits will be.”
So what is the all-payer model?
“For me, it is an approach to aligning payments across payers that makes sure the incentives promote high-quality outcomes for the least, reasonable costs,” Miller said in an interview Wednesday after his meetings with the two legislative panels. It would mean moving away from the current reimbursement model—fee for service—which tends to encourage more procedures and shorter visits with patients.
To implement an all-payer model, “We want permission from Medicare to change the way they pay,” Gobeille explained Wednesday, also speaking after meeting with lawmakers. The state already has regulatory authority to alter reimbursement for Medicaid and commercial insurance companies.
“We want permission to set Medicare rates,”Gobeille said. The state would like Medicare to pay doctors and hospitals based on the providers’ total spending for their Medicare patients and let the “providers take responsibility for the health of a population,” Gobeille said.
On Tuesday, the legislature’s Health Reform Oversight Committee, on which Kitchel serves, spent the afternoon trying to get up to speed on the status of the all-payer initiative.
Miller and Gobeille reported they hoped to reach agreement with federal regulators about the Medicare changes by the end of the year. The two officials said the timeline was necessary in order to launch the all-payer model in 2017. Gobeille explained that commercial insurers would propose rates for 2017 next spring, so they would need to know what the reimbursement model is.
Similarly, Miller noted that the state’s agreement with the federal government about Medicaid, called Global Commitment, expires at the end of 2016. State officials also want the new Medicaid agreement to mesh with the all-payer model.
Miller also suggested there were political reasons for pushing ahead: “We have friendly administrations in Washington and Montpelier. That changes in 2017.”
Lawmakers on the Health Reform Oversight Committee chafed at the aggressive schedule because the state wants to conclude the deal before the legislature reconvenes in January.
“At what point does the legislature weigh in?” House Health Care Committee Chairman Bill Lippert (D-Hinesburg) asked Miller and Gobeille.
Senate Finance Committee Chairman Tim Ashe (D/P-Chittenden) observed, “At present, there is no clear role for the legislature.”
Gobeille tried to reassure lawmakers: “If this isn’t a good deal for Vermont, I will be the first to say so.”
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Another spin of the roulette wheel called health insurance in VT. We need to be first, we want exceptions, let’s spend a little (more) dough…
Repub Congress and soon POTUS. Sure, VT will pull an exemption… Just as soon as the new DC guts Obamacare!
Dream on.
The saga continues. The people in charge of Vermont Health Care from the Governor on down have already proven they are incapable of managing a highly complex program. This is another example of your government at its worse. Government shouldn’t be in the insurance business, they have already proven that with their flood insurance program. But, if they do move into these areas at least appoint people that have some experience in the industry. None of the decision makers involved with Vermont Health Care have experience in health insurance. Only in government can you be appointed to top level positions with no experience. Yet they are allowed to continue on and on with their bad decision making. If they performed that way in private industry they would have been shown the door a long time ago.
I think innovation and experimenting with new models is very smart!
We can try to fix what’s broken, or bury our heads in the sand and say run-away annual increases in private premiums of 20-30% for those with insurance is fine; the private sector being ‘more efficient’ than the state, never mind the uninsured, who die without treatment.
Government steps in when it needs to, because the market fails, not because they are busy-bodies.
The course of the private sector solution for healthcare was less people insured, at unsustainable costs. Similar to college education, these benefits aren’t defined as luxuries, but as rights, in civilized industrial countries, besides the US.
Have we become the nation that kicks the poor and needy aside, so that the top 2-3% of Americans that owns 80+ of all our resources and economic wealth can have even more?
I’m a taxpayer, and I say ‘yes’ to our leaders exploring solutions to problems, versus merely criticizing initiatives, and pretending the private sector efficiently manages anything, besides profits. They are being entrepreneurial, while being accountable to their shareholders, the electorate. Good for them!