In what is becoming a semi-annual event, Chair Al Gobeille met with members of the Roundtable’s Health Care Working Group, chaired by Mike Walsh, to provide an update on progress of the All Payer Model term sheet currently being negotiated with Centers for Medicare and Medicaid Services (CMS). The term sheet describes the basic policy framework that would allow Vermont’s health care providers, payers, and the government to operate an all-payer model. And this framework would ultimately provide an approach to health care payments that reward the health care system for providing high value care and benefit Vermonters.
At its essence the state agrees to coordinate Medicaid and commercial insurers, and commits to financial targets and quality goals, in exchange for which the federal government will allow Medicare to participate in the Vermont system. Gobeille noted that the proposal aims to make health care more affordable by bringing health care spending closer to economic growth; the term sheet sets a 3.5% spending target and a 4.3% spending cap, with a commitment that Medicare will grow more slowly in Vermont than nationally. The financial targets are based on health care services in Vermont’s Medicare, commercial and Medicaid ”shared savings” program today, which covers most hospital and physician services.
Vermont aims to improve quality of care by increasing access to primary care, reducing the prevalence of chronic disease, and addressing the substance abuse crisis. And by working with existing mental health, substance abuse and long-term services and support providers, Vermont will have created an integrated health care system. Al Gobeille and the GMCB, as charged by Act 48, will hold the Accountable Care Organizations (ACOs) financially accountable for quality measures.