Discussing Early Wins with the All-Payer Model

Last Thursday, I was honored to join a lively panel discussion on the early successes of Vermont’s all-payer model (APM). Governor Scott kicked off the event, saying how important it is to understand our state’s value-based care work and continue collective efforts to bend the cost curve. 
The panel was moderated by Dr. Joshua Sharfstein, a Johns Hopkins physician and health reform leader from Maryland who put Vermont into a national context. Citing Maryland’s global budgeting system and other examples, Sharfstein explained why the health care system nationwide is so focused on new ways to pay for and deliver care. The ultimate goal, of course, is to provide the best possible care at the lowest possible cost. 
In that vein, Dr. Sharfstein highlighted a recent study of four states that found only Vermont reduced hospitalizations and achieved significant cost savings as a result of its APM work. He attributed the success in part to alignment of Medicaid, Medicare and commercial payers.
Pointing to the panel—which included leaders from the state, OneCare Vermont, Blue Cross and Blue Shield and provider organizations—he explained that these groups’ collaboration can orient the system around keeping people healthy. Vermont, Sharfstein said, is at the forefront of doing that by paying differently for health care.
After his presentation, Dr. Sharfstein talked with panelists. When he asked me why hospitals support OneCare and participate in the APM, I said they are compelled by the opportunity to focus on wellness, manage chronic care and prevent disease while also ensuring the long-term sustainability of their hospitals. We will always need to treat illness and injury but we can also help prevent the most painful and expensive conditions from occurring in the first place.
As several panelists and Dr. Sharfstein agreed, this work is early in development and takes a lot of time. Together we have to be patient and persistent. Health care reform is vitally important and happens incrementally. We are on a solid path in Vermont, and last week’s dialogue offered evidence.
I am proud of hospitals’ bravery and commitment to making our innovative—and as Dr. Sharfstein noted, unique—all-payer model work for Vermonters.

Jeff Tieman, VAHHS President and CEO