BURLINGTON, VT: On July 29, 2020, Rebecca Holcombe, Democratic Candidate for Governor, released a set of recommendations on reforming Vermont’s health care system.
“As a state, we know we need to transition to universal care. It’s going to take hard work to get there, especially since the federal government is not willing to be a partner at this time. These recommendations are intermediate steps that put us on the tracks towards universal health care. I’m the candidate for Governor with the executive-level management experience to get the job done on these priorities, which will save Vermonters money and keep them healthier,” said Holcombe.
“It is great to hear that Rebecca’s health care proposals build on prevention, primary care and payment reform initiatives. Expanding payment reform and transitioning to prevention-centered care can improve health outcomes for Vermonters. I strongly support her recommendations,” said Senator Ginny Lyons, Chair of the Senate Committee on Health and Welfare.
“Rebecca’s recommendations are spot on. She has a good understanding of the steps we need to move Vermont towards universal health care. Should she get elected, I would look forward to seeing these recommendations implemented, to save Vermonters money while maintaining quality care,” said Rep. Lori Houghton, Ranking Member of the House Committee on Health Care.
“I support Rebecca in the Democratic primary for Governor. Her proposal for transforming Vermont’s health care system exemplifies the thoughtful analysis she puts into her other initiatives: it is informed by best practice and research and it recognizes what is unique to Vermont’s current health care system and builds on that. She has the best interest of all Vermonters at her core,” said Rep. Ann Pugh, Chair of the House Committee on Human Services.
Holcombe worked with many stakeholders in developing these recommendations, including the aforementioned legislators, former Vermont Department of Health Commissioner and former Agency of Human Services Secretary Harry Chen, Governor Howard Dean, and former Senator Claire Ayer.
Proposed Set of Health Care Reform Recommendations
Vermont needs universal health care. We can build a system that keeps Vermonters healthier while reducing our runaway health care costs.
Our state spends one in five dollars on health care. Premiums for qualified health plans increased by 10 to 14% for two years running, and about 1/3 of the increased cost in the education fund is driven by the cost of health benefits.
The old health care model pays providers for treating sickness rather than preventing disease. A better, more progressive model keeps people healthy through quality primary care, good nutrition, mental health support, and more. The old model rewards high cost visits and discourages good preventative care. Prevention saves money and makes our population healthier.
It should also be noted that health outcomes are directly linked to certain factors, including socioeconomic status and race. To make all Vermonters healthier, we have to address those social determinants of health as part of the solution from the start, rather than treating them after the fact.
Vermont faces some of the same challenges other states face: a limited pool of health care workers, a divide between payers (insurance) and providers, and a benefits cliff, which happens when people fall off coverage when they earn too much for Medicaid. We also have unique geographic and technical barriers to providing affordable health care. Our state is sparsely populated with insufficient internet connectivity for telehealth in many areas.
Vermont’s attempt at single payer failed because we couldn’t control costs; we simply don’t have the economy of scale other states have. Yet, our small size can allow us to try innovative models, with right sizing for Vermont. Here are six steps we can take that will lower cost of health care while improving outcomes.
- Expand payment reform. At a minimum, Vermont’s administration needs to finish implementing the ambitious payment reform that the Legislature passed in 2015. The emphasis of payment reform is rewarding providers for offering preventative services. Responsible implementation will create stability for providers, greater profitability, and better health outcomes.
- A pilot program that cuts out the middle person. Hospitals are in a good position to accurately estimate and then control costs, while improving the health and access of patients. This pilot program, set up through an RFP, would create a merged hospital and insurance entity that would receive payment in advance to provide primary, secondary, and tertiary care to all members, while reducing overhead, improving care, and increasing transparency. It would use Medicaid as a base to support people who lost their health insurance when they lost their jobs.
- Global budgeting. Hospitals are essential in rural areas. However, our current model forces rural hospitals to use expensive elective procedures to remain financially sustainable. Population based payments from insurers can provide rural hospitals and providers with stable funding. This allows them to move away from fee-for-service, and provides financial support for prevention activities, to ensure that communities have continued access to essential services.
- Plan for the system as a whole. Not every hospital has to offer every service. If we plan systemically, we are able to ensure essential services remain in our communities while minimizing duplication of services and equipment.
- Develop our health care workforce. Investing in training for health care workers strengthens communities and our economy. We should expand loan forgiveness for primary care providers, strengthen health career pathways, help Vermonters earn nursing credentials in Vermont nursing programs, and use our state colleges to retrain people who have lost work in the pandemic.
- Regional partnerships. We can develop regional partnerships with neighboring states to lead where the federal government fails to lead. We can establish regional purchasing consortia to drive down the price of pharmaceuticals.
Our health care system is cumbersome and inefficient, but the good news is that we can use our small size to streamline services in ways that benefit patients and save people money. Vermont can serve as a model for the nation in reining in health care costs without sacrificing patient care.