Pandemic tests Vermont health care reform efforts

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MONTPELIER, Vt. (WCAX) Vermont over the past several years has been overhauling its health care system, moving from the traditional fee-for-service system to what's called an all-payer model. Even as the pandemic has punched a hole in hospital budgets, the COVID response is putting a new emphasis on the reform efforts.

"It's not all bad news that we hear form this pandemic, we're learning a lot," said Kevin Mullin with the Green Mountain Care Board.

When COVID first broke out, hospitals across the state suspended nonessential procedures and surgeries to prepare for an influx of sick people. "Everybody was in full-blown mode of trying to get hospitals and doctors offices prepared for an onslaught of COVID patients," Mullin said.

This halted the cash flow to providers who charge for each procedure and count on that revenue for their survival. The all-payer model focuses on preventative care, with the goal of reducing expensive hospital visits and chronic care treatment.Over 2,000 providers who've moved to the all-payer system are paid a flat monthly reimbursement through Medicare, Medicaid and private insurance, instead of charging for each individual service. The steady payments helped many stay afloat when the patients weren't there.

"It provided them with consistent cash flow and the ability to be more nimble," said Vicki Loner, the CEO of Onecare Vermont, the organization tasked with rolling out the new all-payer model. The system is still experimental and OneCare must prove it's working to continue to get waivers for use of Medicaid and Medicare dollars. The state wants to exclude this year's reporting requirements because of the pandemic and Loner says the state may need to come up with other ways of telling if reform efforts are working.

"Maybe the measures in the future are access to your primary care that you can do the telehealth or telemedicine visits. Maybe it's just connnecting with your primary care," Loner said.

But for the all-payer model to work, every hospital and health care provider has to be onboard, and those facilities have to stay open.

"A lot of losses out there. We have to stabilize this system for the health of Vermonters and the good of the economy," said Vt. Agency of Human Services Secretary Mike Smith Wednesday.

The Scott administration is working on a $375 million hospital stabilization plan funded by the federal CARES Act.
While the state works toward health care refrom, Smith says it's urgent to keep the health care providers who lost money in good financial health themselves.