MEMBERS PRESENT:

1.        Convene, Review and Approve Meeting Minutes from June 24, 2008 CD #1, TR. 2

Sen. Kitchel convened the Commission meeting at 1:10 PM. 

The Commission approved the minutes from June 24, 2008.

2.a.     Health Information Technology: Review of VITL proposal for Health IT Fund

         Greg Farnum, VITL

         Paul Forlenza, VITL

         Angela Barnett, VITL

 Documents distributed:

• Doc. #1: HIT Fund Proposal
• Doc. #2: VITL's Request for use of health IT fund
• Doc. #3: Project Summary Worksheet

Greg Farnum thanked the HCRC for helping VITL to work on the VITL proposals and restructuring issues over the past several months. He and Angela Barnett reviewed the HIT Fund Proposal from VITL. The core objectives of the Vermont HIT plan are:

·   Encourage and enable the deployment and use of EHR systems within the state to increase the amount of health information that exists in electronic form.

·   Establish and operate the infrastructure necessary to promote secure electronic health information exchange to achieve the plan’s vision.

·   Empower consumers to take an active role in electronic health information initiatives in Vermont.

·   Enable public health agencies to leverage HIT/HIE investments to monitor and ensure the public’s health more transparently and quickly.

Re hospitals to be connected first and later to an electronic health record (EHR) system:

These hospitals have EHR systems and are ready:

Rutland

Brattleboro

Southwest

Northwest

Fletcher Allen

Dartmouth

Central Vermont

St. Johnsbury (Northeastern Vermont Regional Hospital)

These hospitals don’t have the internal technology ready yet:

Porter

Grace Cottage

Newport

Copley

Gifford

Q: re date for expected final completion—all records digitized and accessible?

A: National goal is 2014. But while Vermont is putting funds into this project, the federal government is not yet doing so.

Project Timeline (revised 9/3/08):

VITL’s submitted budget for the Health IT Fund:

CD #1 Tr. 3

Paul Forlenza: VITL submitted this to the Administration last Friday; the Administration has a few questions. They do not expect the total to change. It is $2.7 million. JFO has calculated (estimated) that general fund revenues collected for this fund should be about $3 million.

Discussion followed.

Q: Total payroll for VITL?

A:  8 staff and one new FTE: approximately $1.1 million.

The VITL Summit is Sept. 25^th in Killington. He urges all who are interested in this budget and the proposed work to attend.

CD #1 Tr. 4

2.b.     H.I.T.: Update on VITL governance restructuring

         Greg Farnum, VITL

 Documents distributed:

• Doc. #4: Health Care Reform Commission VITL Governance Update
• Doc. #5: VITL Health IT Fund Grant Application for Fiscal Year 2009

The VITL governance committee:

Don George, BCBS, Chair

Angie Marano, Fletcher Allen

Judy Higgins, OVHA

Lisa Ventriss, Vermont Business Roundtable

Cy Jordan, VPQHC; and they have added:

Jim Hester, HCRC

Timeline:

Aug. 29 is the next VITL board meeting—they hope to have approval of the new by-laws and article modifications.

CD #2 Tr. 1

By Aug. 31 they expect to have a list of nominations for the new board. Sept. 10 is the next annual meeting—hopefully they will approve the new board. And the new board convenes Oct. 8.

Questions and discussion re perpetuation of board after this process.

CD #2 Tr. 2

2.c.     H.I.T: Vermont’s initiative: a national perspective

         Hans Kastensmith, Capitol Associates

Kastensmith:  The proposed reduction in the size of the board is an important piece: it will make VITL more nimble and able to move forward. There is an important question re how it gets re-elected—they may need to consider this.

The money:

The high-level plan is on track. The Administration is working with VITL re proper oversight.

Vermont is unique—has taken a global look at all parts of health care reform—including all key areas. Health I.T. is basic infrastructure. Vermont is ahead of most other states re health I.T. funding.

Discussion of overview and accountability; overview and fiduciary responsibilities of the HCRC.

Hester: The Fund is expressly set up NOT to flow directly to VITL: VITL must apply for the money; it must be approved by both the Administration and the Legislature.

Besio: Agreed; and the Administration is also commissioning an independent evaluation of VITL’s effectiveness.

Bea Grause: VITL is doing an excellent job. She does have questions re what are the problems this restructuring is supposed to address, and will this plan do so?

CD #2 Tr. 3

Document distributed:

• Doc. #6: Statement from Health Care Reform Commission to Secretary of Administration re VITL request for funds from the Health Information Technology Fund

Statement from Health Care Reform Commission to Secretary of Administration re VITL request for funds from the Health Information Technology Fund.

As required by section 7.004 of No. 192 of the Acts of the 2007 Adj. Sess. (2008), the Health Care Reform Commission has reviewed VITL’s Health IT Fund grant application for FY 2009 as submitted to the Secretary of Administration on August 15, 2008.  The commission finds that the projects proposed by VITL are consistent with both the state Health IT plan and with the objectives of the Health IT Fund, and has no suggested changes to the mix of projects proposed.

The Health IT grant application is contingent upon submission of a plan for the implementation of the projects being funded by the grant.  Commission consultants and staff will continue to work with the administration to review the more detailed project plans and resource allocations to ensure that they support the scope of projects proposed. The commission understands that the exact allocation of resources among projects may shift to some extent as a result of this review.

The Health Care Reform Commission also believes, however, that the proposed restructuring of VITL's governance is critical to the successful implementation of the broad scope of projects included in the first grant request. It requests that the funding of grant application be contingent upon the successful implementation of the restructuring of the board, including both downsizing and re-composition of membership, as recommended by the VITL Governance Committee.

Sen. Kitchel introduced this draft statement. Asked commissioners if it is acceptable.

There was discussion re the third paragraph.

The commissioners revised the third paragraph thus:

The Health Care Reform Commission also believes, however, that the proposed restructuring of VITL's governance is critical to the successful implementation of the broad scope of projects included in the first grant request. It requests that the funding of grant application be contingent upon the successful implementation of the restructuring of the board, including both downsizing and re-composition of membership. , as recommended by the VITL Governance Committee.

Sen. Racine moved to adopt the statement as modified. Motion seconded and passed unanimously.

The staff will send this as a memo to the Administration.

CD #2 Tr. 4

3.a.     Commission Studies for 2008-9: Status of three approved studies

         Jim Hester, Director, HCRC

Three studies have been approved by the Commission.

The e-Prescribing study has been let to Point of Care Partners; they are beginning their work; forming a workgroup. Work is under way.

The study on merging risk pools: they have let the contract to Elliott Wicks; will be starting in September.

Q re work group and input: this is more a stand-alone study; need to discuss re getting public/stakeholder input during process. Plan currently is to have him do the study, then get response.

The public financing study: List of questions has been circulated broadly, gotten interesting dialogue. Workgroup being formed. Consultants now refining the lists of questions.

Statement re controlling health care costs, as requested by Commission—in draft; soon be ready to be circulated to Commission and interested parties.

Q: re some specific comments from the Vt. Chamber of Commerce—will their questions be addressed?

A: Jim Hester will review the large number of questions—will check this and get back to Duane Marsh.

3.b.     Commission Studies: Community budgets / ACO feasibility study

         Jim Hester, Director, HCRC

Document distributed:

• Doc. #7: Feasibility Study for Pilot of Community-Based Payment Reform: Summary

Jim said that this has not been approved yet by the Commission.

This summary highlights the purpose; major issues; and key questions regarding the design and implementation:

·    scale and scope of the pilot

·    responsibilities of the ACO and criteria for ACO participation

·    design of the incentive system

·    administration and funding of the pilot

Will not be a detailed design of the pilot—but will identify issues. Caution: This is a key element of health care reform: payment system. It is an extremely ambitious undertaking to put together payment reform; may not be feasible.  Are conditions right in Vermont at this time to take a look at this?

Staff will identify a work group of key stakeholders for this project.

Jim Hester has a proposal from KNG Consultants. Limited to the $50 thousand in the Commission budget for this work. They will draft a white paper; work with Jim Hester in staffing the workgroup or multiple workgroups for this project. KNG were the consultants who did the design for the Blueprint—primary care payment reform. They did an exceptional job in supporting the Blueprint in this. They are they only option Jim considered for doing this work.

Q: Timeframe seems aggressive, considering the scope—just three months.

A: From the perspective of the higher scan, overview: should be able to assess at a high level and make a recommendation for continued work.

Discussion of overall reform of delivery system-- responsibilities of the ACO and criteria for ACO participation; implementation issues.

This is a hugely complicated issue.

One key issue: what scale is needed to implement—small, or regional across multiple hospitals?

Note from Sen. Mullin: Jim did a presentation re health policy reform to the Council of State Governments (CSG)—this was a high point of the discussion, and well received. Alas, there is little to be learned from other states.

Sen. Kitchel: Re approval for this ACO study—this was actually done at the last meeting. No further commissioner action needed now.

CD #2 Tr. 5

4.a.     Health Care Reform Implementation: General update

         Susan Besio, Director, Health Care Reform Implementation

Documents distributed:

• Doc. #8: Vermont Health Care Reform, Summary, August 2008

[Includes the document “National Recognition of Vermont’s Health Care Reform”.]

[These documents will also be posted on the HCRC website.]

It is important to step back, see the context of all Vermont’s initiatives in health care reform, and also see this work in a national context. This document is a PowerPoint that she uses nationally. It shows the three years of most recent legislation; all the new initiatives in Vermont. Illustrates that Vermont is simultaneously trying to address the three major areas:

·    Increase access

·    Improve quality

·    Contain costs

Over 60 different initiatives are actively happening. The PowerPoint lists the details of these initiatives.

CD #3 Tr. 1

Susan Besio also presented information on national recognition of Vermont’s health care reform efforts—national publications and journals. We are way ahead of the national average.

She discussed various elements of the Vermont initiatives in more detail.

Information from Christine Oliver, BISHCA: The multi-payer database has been developed; on Sept. 10^th will go before Legislative Committee on Administrative Rules.

Re the Besio PowerPoint: will be available on the Administration’s Health Care Reform Website in next few weeks. Commissioners can use this in presentations.

Comments: This will be very helpful.

CD #3 Tr. 2

4.b.     Health Care Reform Implementation: Patient Safety and Surveillance System

         Jill Olson, Vt. Assoc. of Hospitals and Health Systems

                                           Donald Swartz MD, Medical Director, Vermont Dept. of Health

Swartz:  Significant progress, with help from partners.

Background: 2000 national report, “To Err is Human”: between 44,000 and 100,000 deaths per year in U.S. from medical errors. This is more than all accidental deaths; more than from breast cancer; more than twice the number of deaths from AIDS. No specific Vermont data, but they assume Vermont is not immune.

In 2006 Vermont passed Act 215; this included setting up Vermont’s patient safety and surveillance improvement system. This is a quality improvement, but not a regulatory, activity. Solutions need to be developed by local entities.

Dr. Swartz discussed overall components of this quality improvement: systemic issues, accountability, reporting, quantifying trends. The patient safety program allows reporting and discussion to happen in a confidential way. The information will be used to identify areas of risk so they can adjust their procedures for quality improvement.

Reporting: first report delivered to Legislature in Jan. 2008; second one due out soon; data will also be reported by BISHCA.

Progress to date:  developed Rules to flesh out the statute—vigorous process.

Collaborative process; have set up database that can handle various kinds of data from hospitals; working with VAHHS.

[See VDH website on this: http://healthvermont.gov/hc/patientsafety.aspx  ]

Their To Do list:

1.      Determine the best way to analyze the data as it comes in;

a.     Impact of economic factors; economic impact of errors

b.     Costs

c.     which data need to be included in hospital reports

d.     Evaluate effect on errors of the patient safety program

2.      Determine direction of patient safety program in the future

Jill Olson: Vermont is far ahead of other states, especially reporting on infection rates: initial sets of data are available on VAHHS web site.

This has been a very collaborative process with Vermont hospitals. They are working with various entities to avoid duplication of data collection. As well as doing legislative reports, will do a public report.

She has other issues to report on. Kitchel: In the interest of time, will put on future agendas.

CD #3 Tr. 3

6.        Impact of Proposed Budget Rescissions on Health Reform

6.a.     Rescission: Overview of Process

         Sen. Jane Kitchel, Commission Co-Chair

Sen. Kitchel introduced the process and timeline.

 Q: Commissioners are getting calls from various concerned health care providers.

A:  A list is on the JFO website:

http://www.leg.state.vt.us/jfo/Budget%20Rescissions.htm

6.b.     Rescission: Summary of proposed rescissions

         Susan Besio, Director, Health Care Reform Implementation