More on Budgeting

Work continues toward single-payer system in Vermont

The Green Mountain Care Board (GMCB), recently outlined its second year of work as it helps guide the state towards a publicly financed single payer healthcare system by 2017.

In addition to regulating commercial insurance rates and community hospital budgets, the independent advisory board is overseeing several payment and delivery models for Medicare, Medicaid and commercial payers going into 2015, as some of the plans for the single-payer transition (including the health insurance exchange) are still being designed.

With a five-member board and a staff of 16, the GMCB has pending proposals with Centers for Medicare & Medicaid Services (CMS) to test several payment models based around shared savings accountable care organizations, bundled payments and pay for performance.

In 2012, the GMCB coordinated and helped design several payment reform models. In St. Johnsbury, the board is guiding a coordinated oncology care pilot that’s somewhat experimental, with doctors and providers helping design the future payment contracts and Lebanon, N.H.-based Dartmouth Hitchcock Medical Center researchers tracking performance.

In Rutland, the GMCB is working with a federally qualified health clinic and the Rutland Regional Medical Center, the state’s second largest hospital, to developed physician- and hospital-based global budget payment systems. The GMCB is also developing standards for accountable care organizations and integrated care networks that can cover both commercially-insured Vermonters and Medicaid members.

In its regulatory authority, as established by the 2011 state law known as Act 48, the GMBC has provided financial oversight of providers and payers, while also acting as a consumer ombudsman and incorporating public comment processes into planning.

In 2012, the GMCB reviewed and approved budgets for the state’s 14 community hospitals, including Rutland Regional and Fletcher Allen Health Care, setting target increases for net patient revenue of 3.75 percent for the 2013 fiscal year, down from 4.5 and 4 percent during the past two years.

The GMCB also developed its role in setting insurance rates in 2012, reviewing, approving or modifying the decisions of the Department of Financial Regulation, with the process open to public comment.

“This has been one of our most challenging tasks to date,” wrote the GMCB, led by executive director Georgia Maheras, a consumer rights attorney. “Of all the Board’s duties, our actions on rate review tend to have the greatest immediate impact on Vermonters. For this reason, we devote special attention to public outreach on rate review.”

Since rate filings last April, the GMCB completed 39 reviews, holding public hearings in 12 of them, rejecting two and approving and modifying the rest.

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