How Vermont paved the way
An aerial view of the Fletcher Allen Health Care campus. ¬ Fletcher Allen Health Care
There is an increased understanding that duplicating past efforts by government to control health care costs by simply reducing payments to physicians and hospitals will result in barriers to health care services at a time of even greater need due to an aging population and the increased prevalence of chronic diseases.
Many now believe that in order to provide high-quality, cost-effective health care, there needs to be a greater emphasis on developing new systems of care that improve coordination between a patient’s health providers and allow patients’ clinical information to follow them through their various health care settings. This national movement toward the development of population-based, integrated health care systems of care — or accountable care organizations — has been heavily influenced by the work of Vermont political leaders over the last 20 years.
In the early ’90s, Gov. Howard Dean’s health care authority developed plans for achieving universal coverage that included integrated systems of care operating under a budget in order to provide all of the health care services for Vermonters in different parts of the state.
At the federal level, Sen. James Jeffords worked with Dr. Jack Wennberg from the Dartmouth Institute to develop a new Medicare demonstration project of geographically based health care systems for Medicare patients. These systems, authorized under Section 646 of the Medicare Prescription Drug Act of 2003, focused on provider accountability for the integration of care for managing patients with chronic disease supported by reforms in the reimbursement system.
Dr. Elliott Fisher, also from the Dartmouth Institute, built on the efforts of Sen. Jeffords and Dr. Wennberg to call for the development of what he called accountable care organizations. He was successful in working with Rep. Peter Welch to include the ACOs in the 2010 federal Accountable Care Act. And when the initial regulations around these ACOs were deemed to be too rigid, Rep. Welch reached out to health care organizations, including the Vermont Medical Society, in a successful effort to make the program more attractive to Vermont caregivers.
Under the final ACO regulations, these Medicare shared-savings plans are able to earn three years of savings with no penalties as long as they successfully demonstrate Vermont seniors are satisfied with the care they receive and that they are able to provide accountability by reporting on a series of 33 patient satisfaction and clinical recommendations.
Vermont now has two of these ACOs: the Accountable Care Coalition of the Green Mountains, LLC, which consists of 100 independent physicians statewide and received designation as an ACO beginning July 1; and OneCare Vermont LLC, formed by Fletcher Allen Health Care and Dartmouth-Hitchcock Health, with a statewide network of providers that includes all but one of Vermont’s community hospitals, two federally qualified health clinics, five rural health centers and 58 independent physicians practices. If OneCare Vermont is approved, it would start being accountable for patient care Jan. 1.
These two organizations will be testing the thesis that the state’s physicians and hospitals can demonstrate, through rigorous documentation, their ability to improve on the already high quality of care being provided to Vermont seniors through better coordination and the sharing of clinical information to deliver more cost-effective care. Based on my past work with Gov. Dean and Sen. Jeffords in seeking to achieve similar goals, I wish them every success.
Paul Harrington is executive vice president of the Vermont Medical Society.