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Vt., of all places, may try some healthcare reforms pushed by GOP, too


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.”

T0 read more please hit this link.

Feds give preliminary OK to Vt. ‘all-payer’ plan


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.

Boston-based physician-notification service expands to Vermont


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?

Colo. to vote on single-payer plan



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.



States’ surging role in healthcare-payment reform


Readers would do well to read this Hospitals and Health Networks article by Ian Morrison about the states’ expanding role  in healthcare reform. He focuses on the fact that more  and more states, with huge purchasing power, are consolidating their purchasing  activities and coordinating with private players.

“Increasingly, states including Washington and Arkansas are using this combined purchasing power to transform the healthcare marketplace and coordinate their payment reform efforts with private purchasers. Public purchasers (acting in concert with willing private purchasers) can have a powerful influence on healthcare transformation.”

He writes that the states will:

  • “Drive value-based purchasing across the community, starting with the state as ‘first mover.”’
  • “Improve health overall by building healthy communities and people through prevention and early mitigation of disease throughout the life course.
  • “Improve chronic illness care through better integration of care and social supports, particularly for individuals with physical and behavioral ‘co-morbidities.”’

Mr. Morrison cites Washington State’s Health Care Innovation Plan, which we at Cambridge Management Group are very familiar with because of our ongoing work in Oregon and Washington State.

In that plan, “foundational building blocks” include, he notes, “robust quality and price transparency, activated and engaged individuals and families, regionalized transformation efforts, accountable communities of health, leveraged state data capabilities, practice transformation support, and increased workforce capacity and flexibility.”



Other examples in his piece include:


  • “Arkansas has initiated multi-payer-based episodic payment initiatives and patient-centered medical home programs.
  • “Minnesota’s multi-payer payment and delivery system reform strategy primarily is tied to spreading an ACO concept (the Minnesota Accountable Health Model framework) among Medicare, Medicaid, commercial payers and self-funded populations in the state.
  • “Oregon’s recent multi-payer efforts center on spreading the coordinated care organization model {like ACOs} introduced into the state Medicaid program in 2012.
  • “Vermont is at the forefront of state efforts to reform its health insurance payment and delivery system, and continues to actively test value-based payment approaches with multiple public and private payers.”

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