Looking toward Mt. Mansfield, the summit of Vermont.
— Photo by K. Kemerait
Paradoxically, generally Democratic Vermont (but now with new Republican Gov. Phil Scott) could be setting the pace for some of the healthcare reforms touted by by the Trump administration and the Republican Congress.
The Green Mountain State won got a broad federal waiver last October to redesign how its healthcare is provided and paid for. This includes new payment systems, a stepped-up effort to prevent unneeded treatments, cutting overall growth in the cost of services and drugs, and more effectively dealing with such public-health problems as opioid abuse.
The six-year initiative follows a failed effort under former Democratic Gov. Peter Shumlin to adopt a single-payer plan for all residents.
The hope is that the program eventually will involve 70 percent of the state’s population, almost all of its 16 hospitals and 1,933 physicians and would include patients covered through their employment as well as those in Medicare and Medicaid.
Med City News noted that while the Obama administration approved the experiment it “fits the Republican mold for one way the Affordable Care Act could be replaced or significantly modified. The Trump administration and lawmakers in Congress have signaled that they want to allow states more flexibility to test ways to do what Vermont is doing — possibly even in the short-term before Republicans come to an agreement about the future of the ACA.”
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The Vermont State House, in Montpelier, the nation’s smallest state capital.
VTDigger reports that the federal government and Vermont have drafted a preliminary agreement to implement an “all-payer” healthcare payment system.
Under the model, payments to physicians from commercial insurers, Medicare and Medicaid would be based on monthly fees instead of fee-for-service. Physicians would operate under an Accountable Care Organization — either OneCare Vermont or Vermont Care Organization — which would accept the payments. The ACO would then pay physicians based on quality of care.
The deal would make Vermont the first state to implement an all-payer system for all providers. Maryland now has the only U.S. all-payer system, but just for hospital services.
The Vermont model aims to keep certain costs paid by Medicare, Medicaid and commercial insurance from growing more than 3.5 percent a year for five years, starting in 2018.
The state aims to have about 30 percent of primary-care providers under the model by Jan. 1, 2018, with 80 percent over a five-year period. If OneCare ACO decides to join the all-payer model, the state would reach the initial 30 percent goal.
The Green Mountain Care Board would regulate the ACO. Gov. Peter Shumlin said the all-payer model could save Vermont about $10 billion over 10 years.
To read the VTDigger story, please hit this link.
PatientPing, a Boston-based physician-notification startup, is expanding its service to Vermont, in an agreement with that state to put its software in hospitals across the state to try to improve patient care by boosting communication among providers.
The Boston Herald reported that PatientPing alerts physicians when patients are admitted to emergency rooms or see specialists. For example, primary-care physicians could get alerts when their patients are admitted to emergency rooms, and again when they are discharged or moved within hospitals. The alerts only include admission information.
“Doctors can also make a list of high-risk patients who, for example, are elderly or have chronic conditions for closer monitoring,” the Herald reported.
But, we might ask, how much more real-time communication can clinicians take in their increasingly frantic lives?
Downtown Vail., Colo.
The Denver Post reports that Colorado residents will vote in the 2016 election on a single-payer, state-sponsored health-insurance system
Under ColoradoCare, state residents would choose their own health providers, but the state would pay for it, in a system similar to France’s.
The estimated cost of the program is put at $25 billion a year, to be paid through a proposed 10 percent payroll tax.
Employers would pay 6.67 percent of the tax and employees would pay 3.33 percent. Still, The Post reports, “supporters are optimistic that the benefit will outweigh the costs to Colorado residents, since it will save them $5 billion annually while still receiving the same premium healthcare.”
Nationally watched plans to implement a single-payer plan in Vermont have so far been blocked by fiscal issues.
Meanwhile, some have suggested that consolidation among private-sector health insurers should be encouraged to ease their ultimate merger into Medicare for all.