This commentary is by Patrick Flood, a former member of the Mental Health Division and the Disability, Aging and Independent Living Division. Julie Wasserman, an independent health policy consultant who has worked for the Vermont Government for over 25 years. Mark Hage, Director of Benefits Program in NEA, Vermont. Fat Snell is a staff nurse in the intensive care unit of UVM Medical Center and chairman of the National Federation of Teachers-Vermont and Vermont Nurses and Medical Professionals Federation, Local 5221.
The Green Mountain Care Commission recently testified in Congress calling for a major shift in the way Vermont pursues healthcare reform.
There are three main components.
- Design and implement a hospital “global budget”.
- Invest in community-based health services that keep Vermonter healthy and productive outside the hospital, including primary care, nursing, mental health, and home care.
- Discuss with Vermonters what you are looking for in your healthcare system and how the proposed reforms should take place.
Proponents have sought these changes and more over the years, but the state is accountable despite its failure to reduce costs, increase access, or significantly improve quality of care. I stubbornly stuck to a certain care organization model.
Why change? Perhaps the state has finally accepted that accountable care organizations cannot achieve what Vermonters and our healthcare system really need. This is acknowledged in a recent comment to the Joint Legislative Committee by Jessica Holmes, a longtime member of the Green Mountain Care Commission.
“We are not on a sustainable path,” she insisted. Then more clearly:
“But Vermonters aren’t winning right now. Healthcare isn’t affordable for many families. Many Vermonters don’t have access to primary care, dental care, and other important services. Our mental health. The health care system is far from meeting the needs of Vermonters, and the story that people are having a hard time finding care is really heartbreaking. “
“It is important that this payment reform is in parallel with the redesign of a patient-centric, community- and provider-inclusive healthcare delivery system.”
Kevin Mullin, chair of the Green Mountain Care Board, also testified in support of this new direction, implemented the proposed changes, and demanded $ 5 million from the Legislature to carry out public dialogue and planning processes. ..
Recently, on behalf of a coalition of Vermont organizations that oppose the accountable care organization model, we met with a federal leader who oversees the “Full Payer Model” contract. We emphasized the Union’s support for fundamental changes in Vermont’s health care planning, delivery, and funding.
Our original purpose was to oppose the renewal of the full payer model contract. However, after the Green Mountain Care Commission has announced the general terms of the new reform plan, we should instead fix all changes to the objectives of universal access, affordability, impartiality and public accountability. We have chosen to express our support for the Commission’s latest initiative, provided it must, and quality care.
In the next phase of reform, we need to prioritize:
- Global budgeting for hospitals is structurally necessary. Simply put, the global budget is a fixed annual payment to hospitals to cover verifiable operating costs and make those costs predictable and sustainable. Hospitals can save on administrative costs by not having to charge for all procedures if they have the necessary funds. Global budgets also give hospitals the creative and flexibility to assist patients in ways that make current funding flows impossible or overly complex. However, global budgets should not be designed to unreasonably limit funding or reduce critical services. Also, hospitals’ global budgeting needs to reorder current spending and billing practices that have proved to be overkill and inefficient, so they cannot be “burned” into future budgets.
- Global budgeting and other reforms mean that there is no compelling reason to maintain a publicly funded and accountable care organization model beyond 2023. That money will be invested wisely by providing and improving local care.
- The state incorporates regular feedback from healthcare providers, patients, employers and advocates to monitor and regulate the hospital’s global budgeting and enhanced community care delivery systems at a higher level of public awareness. It is necessary to ensure accountability.
- Labor challenges need to be resolved, starting with a serious shortage of primary care physicians, physician assistants, nurses and nurse aides, and mental health professionals. For too long, states, healthcare managers, and accountable healthcare organizations have been unable to address this issue head-on, and many of the healthcare systems are currently in dire straits. Fortunately, we have proven recruitment and retention solutions such as competitive wages and benefits, debt reduction programs, and improved working conditions.
- Major investments in community care—primary and preventive, nursing-led, home, mental health—are very important to prevent or intervene in early health problems to avoid unnecessary pain and more costly care. Is important to. This is common sense. Still, for too long, our healthcare leaders have focused primarily on our hospitals at the expense of community-based services.
- One of the most obvious problems is the deterioration of the mental health system, which needs to be fixed. Most physical health problems are caused or exacerbated by mental health problems and trauma. Today, our community-based capabilities are so severely compromised that we are denying access to services and support that prevent people from falling into crisis and reduce costs.
- It is important that the Green Mountain Care Board work diligently with local communities and advocacy groups to design and implement new reform initiatives.
There will be a lot of opposition to this new direction from the powerful forces given to the status quo. However, the status quo for the past five years has done nothing to improve access to Vermonter’s care or reduce costs, while pretending to be a “payment reform.”
A new direction for the Green Mountain Care Board can achieve much of this by directing funding from expensive and avoidable care to prevention and early intervention. The savings from that systematic shift can be used to extend critical services and further reduce costs.
I agree with Mr. Holmes. It’s time for the Vermonters to begin a “victory” on healthcare reform. Let’s get to work.
