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Green Mountain Care Board Highlights Reform Success Stories

March 01, 2019

As Vermont continues its pioneering work to create a health care system based on value and wellness, the Green Mountain Care Board featured examples of the All-Payer Model’s benefit to patients at a well-attended hearing last Wednesday.

A longtime leader in health reform, Vermont agreed nearly three years ago to adopt the All-Payer Model (APM), which changes the payment system to focus on quality instead of quantity, and prioritize keeping people healthy over waiting for them to be sick.

This focus on prevention and primary care was a centerpiece of the GMCB hearing. The panel discussion also focused on various ways partnerships are being employed to surround every patient with holistic and complete care. 

“Now it is financially viable to keep your patients and community as healthy as possible,” said Dr. Stephen Leffler, chief population health and quality officer for the UVM Health Network, and one of several speakers on the panel from hospitals and other industry segments (all the panelists are listed following this article).

Caregivers spoke about how many of their patients are experiencing a shift in the quality of life because chronic conditions are better monitored and managed. Physicians and nurses described care coordination efforts that were far more difficult—if not entirely impossible—under a fee-for-service system.

Examples include embedding psychiatrists and dieticians in primary care offices, enabling home health visits and putting resources into palliative care.

Providers’ ability to access key information, including the data available through OneCare, is something “I never thought I’d see in my lifetime,” said Jill Lord, RN, Director of Community Health at Mt. Ascutney Hospital.  Jill also spoke about how integration of the health care system improves service, outcomes, and the patient experience.

A common element of all panelists’ remarks was their shared commitment to making patients the focus of the model.

Dr. Judy Fingergut, a family physician at Northwestern Medical Center, explained how one of her patients who has diabetes and other health conditions could be better managed in the APM framework. Being able to visit her home and develop a customized care plan with the patient herself enabled this particular patient to undergo additional procedures that have enabled positive lifestyle changes. 

Panelists also spoke of the importance of patience and persistence. Health reform work takes time and commitment—and an understanding that real systemic change does not happen with the wave of a wand.

Although it is difficult to implement a new payment and delivery model, “not changing the [current] system is the worst thing that could happen,” Dr. Joe Haddock, a family physician at the Thomas Chittenden Health Center, said at the hearing, which was attended by many legislators in addition to the general public.

Participation in the APM is voluntary, as a couple of panelists pointed out to illustrate the level of progress that has been achieved. Nearly every Vermont hospital is now participating in the APM to some extent because they see it is the most promising path forward.

As additional health care partners join and support the APM, the success stories featured on last week’s panel will only grow and amplify, especially as the data analytics and care coordination dimensions of the model become stronger.

To be sure, there is still significant work to do, including educational efforts like last week’s panel to ensure state leaders and residents alike understand the reform effort and what it is already achieving.

The panelists on last week’s GMCB panel were:

·         Dr. Stephen Leffler, Chief Population Health and Quality Officer, University of Vermont Health Network

·         Dr. Joe Haddock, Family Medicine, Thomas Chittenden Health Center

·         Carla Kamel, Community Care Coordinator, Mt. Ascutney Hospital and Health Center

·         Jill Lord, RN, Director of Community Health, Mt. Ascutney Hospital and Health Center

·         Dr. Carrie Wulfman, Chief Medical Officer, Porter Medical Center

·         Alison Wurst, Director of Population Health and Care Management, Porter Medical Center

·         Judy Peterson, President and CEO, UVM Health Network Home Health and Hospice

·         Dr. Elisabeth Fontaine, Lifestyle Medicine, Northwestern Medical Center

·         Dr. Judy Fingergut, Family Medicine, Northwestern Medical Center