Making sense of Vermont’s all-payer health care model

BURLINGTON, VT    |     WCAX-TV    |    By Kyle Midura  – CONNECT    |    June 28, 2017

Original article can be found at: http://www.wcax.com/

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The next step in Vermont’s latest health care experiment will change the way almost 150,000 people interact with their doctor. The idea is to pay care providers to keep patients healthy, not for every prod, poke and test. The idea would be fully implemented in Bennington, Berlin, Brattleboro, Burlington, Middlebury, Springfield and St. Albans. Administrators say it promises big savings if lawmakers in Washington, D.C., stay out of the way.

Jan. 1, eight hospitals, three federally qualified health centers and dozens of primary specialty care providers, among others, will receive checks totaling more than three-quarters of a billion dollars. That cash will cover 137,000 Vermonters’ health needs for the year regardless of how much care they need or how costly it is.

“This is about keeping healthy people healthy,” said Jill Berry Bowen.

It’s the latest extension of the all-payer model where care providers are compensated for keeping populations healthy, not billing per procedure. It’s on the network of nurses, doctors and hospitals known as an accountable care organization to contain costs. Savings are shared; if the system goes over-budget, the cost falls to hospitals.

“The magic of this health care transformation is going to happen in the primary care offices,” said Dr. Mark Depman, Central Vermont Medical Center.

That’s because prevention is cheaper than chronic care, so the prescription is more checkups and fewer emergency visits.

The weak point in the plan is the patient. Doctors need to be able to convince them to follow instructions, avoid bad diets and address issues with addictive substances.

“Even if you touch and impact a handful of patients, that may be enough in every community to help us do well and do some prevention,” said Todd Moore, OneCare CEO.

If all goes according to plan, rising health insurance costs may only slightly outpace inflation growing at about 3.5 percent.

“Vermont is a state that can’t afford another period of six, eight, ten percent cost growth in health care; it’s just unsustainable,” said Moore.

Costs could fall in the long term, but in the health care world, becoming only slightly more unaffordable year-over-year would be a big relief.

Part of the reason Vermont pursued the all-payer model is because it could help limit any impacts from federal rollbacks of the Affordable Care Act. But administrators of the accountable care organization say if lawmakers move forward with repeal and replace, it would cause a major disruption to the state’s entire health care system.