Payment Reform and the Blueprint for Health
The conference in Stowe was sponsored by a SIM grant to the state from CMS. The innovations presented ranged from collaborative efforts to use lab resources more efficiently to the practical approach to the reality that Vermont has a critical shortage of general surgeons. On Saturday the discussion of the future continued with a panel of clinical leaders and healthcare executives discussing the “Future of Payment Reform”.
Vermont has been actively trying to find its way to a better system of care since the 1990s. Since 2006 “The Blueprint for Health” has been Vermont’s state-led initiative to implement PCMH related initiatives in every practice in the state. Since 2010 Vermont law has defined the Blueprint as a “program for integrating a system of health care for patients, improving the health of the overall population, and improving control over health care costs by promoting health maintenance, prevention, and care coordination and management.”
“The Blueprint” has had some successes and some failures. As is true with all attempts to create meaningful change, the journey to the vision of all Vermonters getting care in a medical home environment has been slow. Meaningful change in social and professional systems is always slow and there are always barriers. The critics accentuate the barriers and the proponents inflate the successes. The “Blueprint” vision was laudable but incomplete because it did not adequately address issues of finance and the integration of the primary care medical home with the rest of the care delivery system. Now the Green Mountain Care Board has broad authority that may accelerate the journey toward the vision that the Blueprint is seeking to describe.
Creating a confluence of resources that are an alternative to single payer and supporting the evolution of a single ACO that will be the delivery mechanism that combines the improved primary care practices with the hospitals and specialists as one integrated system are the dual challenges that the Green Mountain Care Board has the authority to assign to itself. Vermont through its legislature and its own experience has created a moment of opportunity that is truly remarkable.