115 State Street |
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SEN. M. JANE KITCHEL, CO-CHAIR
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STATE OF VERMONT |
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GENERAL ASSEMBLY |
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COMMISSION ON HEALTH CARE REFORM |
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MINUTES |
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Friday, September 28, 2007 |
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Central Vermont Medical Center |
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Berlin, VT |
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115 State Street |
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SEN. M. JANE KITCHEL, CO-CHAIR
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STATE OF VERMONT |
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GENERAL ASSEMBLY |
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COMMISSION ON HEALTH CARE REFORM |
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MINUTES |
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Friday, September 28, 2007 |
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Central Vermont Medical Center |
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Berlin, VT |
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MEMBERS PRESENT: | SEN. M. JANE KITCHEL, CO-CHAIR, REP. STEVEN MAIER, CO-CHAIR, SEN. KEVIN MULLIN, REP. HARRY CHEN, REP. MARK LARSON, REP. FRANCIS MCFAUN, JOHN BLOOMER, JR., WALTER FREED |
MEMBERS ABSENT: |
SEN. ANN CUMMINGS, SEN. DOUG RACINE |
Also Present: |
Legislative and Joint Fiscal staff, members of the Administration, and the public. |
Meeting Recorded: |
Meeting recorded: CD HCRC 9/28/07, CD #1 & CD #2 |
Documents Distributed: |
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| Witness List: |
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1. Convene,
Convene, Review and Approve Meeting Minutes [TRs 1-4 were testing] Rep. Maier and Sen. Kitchel convened the Commission meeting at 2:20 PM. The Commission approved the three sets of minutes. 2.
Implementation
Updates b. Enrollment
simplification: brief status report Susan Besio c. Blueprint for Health:
update on pilot programs in payment reform and local care coordination Susan
Besio Documents
distributed: Susan
Besio gave an update on the Catamount Health rollout. They are on schedule and
in good shape. The website will be live early Monday morning (Oct. 1). The
rules have been approved for the premium assistance programs. All positions are
filled for the eligibility and enrollment specialists, and all staff is
trained. All the software is on schedule and tested. They have revised the
application forms to include premium assistance. They are creating an
electronic interface system re enrollment, among Blue Cross, MVP, and the
State. All
1,150 people who contacted the state re Catamount Health have received
application forms. They will start processing applications this Sunday, Sept.
30. Marketing
strategy: They are doing a “soft launch” through October—low-key press. Then
starting Nov. 1, will do the “hard launch”: major media, including TV ads,
press conference with the Governor, radio shows, hope for newspaper coverage,
etc. The TV ads will be general: the message is that we want all Vermonters to
have health care coverage—under the umbrella of Green Mountain Care. The website
will help address misunderstandings about the programs. Besio
also discussed the focus groups that they used to prepare and refine the media
messages. Overall,
they want to market all the health care programs together, as a range or
continuum. b.
Enrollment simplification: She will give a more detailed update at October
Commission meeting; they have two consultants reviewing forms, to give
recommendations. Have a draft report; have asked consultants to come give a
presentation at the next Commission meeting. c.
Blueprint for Health: update on pilot programs in payment reform and local care
coordination: Document
distributed: They
have conceptual agreement on this model. The model has a medical home, with the
main provider, and a community care team, funded by all the providers. This
team would coordinate among patient, providers, community health programs,
hospitals, etc. After discussions this summer, the Blueprint model has
“conceptual agreement” among almost all the major funders. Even Medicare has
expressed interest. The plan would be for this model to work eventually across
all chronic conditions. Besio
and commissioners discussed a possible in-service training on Dept. of Health
programs, public health infrastructure, for the Commission and the three health
care committees in the legislature, plus other interested legislators. They are
planning this with commission staff. Q:
Any projections for the financial resources needed for these pilots and the
Blueprint work, especially disease management? A:
Craig Jones is reviewing budgets—these projections are under way. The
RFP went out today to Blueprint sites, re pilots for this integrated model, re
being an integrated pilot—including medical home, integrated across payer, etc. Blueprint
Integrated Pilot: Payment Reform Model:
1.
Initial financial Reform: Jim
Hester: Last spring, we discussed that this was a very aggressive timeline—and
he would like to acknowledge the impressive achievements so far. Discussion
of chronic care teams: first, it must make it easier for the providers to do
their job. Other major concern: Blueprint chronic care model vs. OVHA model.
Unfortunately, the Vermont legislation mandated an external vendor for
Medicaid—so this has complicated the Blueprint chronic care model considerably. 3. VITL
Greg
Farnum and Paul Forlenza CD #1, TR 6 a. Electronic medical
record pilot §
Fund
raising §
RFP a. Update re Workgroup
#4 Documents
distributed: Commissioners
recognized Greg Farnum for an award: he has received the Leadership of the Year
Award from the New England Chapter of the Healthcare Information and Management
Systems Society (HIMSS). Quick
update on the Health Info. Tech. Plan: submitted July 17, many views on their
website; letter from Dr. Robert Kolodner, the new HIT czar for the
country—praising the plan, and VITL’s leadership role. Medication
history pilot: fully operational at both Rutland and Northeast hospitals. They
are getting great results. Over 20,000 patient record transactions since May.
It is an op-in process, get patient consent up front; 89% of patients do
consent. There is a video on the VITL website: “The electronic medication
history service”: http://www.vitl.net/tv.php/sid/28 . VITL
is working on revising and expanding this project in Vermont. Forlenza:
some unexpected nice side effects: primary care practitioners are finding that
when their patients do go to the emergency room, their medication lists get
updated and are much more accurate. The
electronic Health Record pilot project: Was set up in H.229, here is an update.
They are seeing a huge demand for EHRs—here and nationally. Fletcher Allen HC
and Southwest Vt. Med. Center both plan to provide EHRs. Nationally, vendors of
the systems are backlogged; long waiting times now. Lots of inquiries to VITL
from Vermont practices. VITL
will use a “request for information” to vendors to prepare a list of
pre-qualified vendors so they can make recommendations when practices inquire.
They expect to list 5 to 10 vendors. They will also run a competitive process
for local practices to be pilots for EHRs. They will announce the details at
the October 19 summit in Burlington. The
third prong to the strategy: Once they have selected these practices, they will
work with them to develop and RFP for vendors. Re the January 1 deadline in the
legislation: they do expect to miss this deadline, but should complete the
process by the end of March. Re
fundraising: Goal of $1 million; now have commitments for $500,000; but will go
ahead, with fewer practitioners; they are still working on getting more
funding. CD
#2, TR 1 Discussion
of interoperability of different EHR systems; public domain products—the
tremendous importance of technical training and support for staff after a
practice installs an HER system. So this is a problem with public domain
systems. Vermont and West Virginia are looking at this issue. VITL
has a resource area on their website for physicians, and a discussion forum.
Also, guidelines for contracting with EHR vendors. Discussion
of policy issues re Vermont’s statewide health information exchange network;
privacy and security issues. CD
#2, TR 2 4. Commission
Workgroups Jim
Hester a. Overview of workgroup
and commission meetings for October: b. Summary of Workgroup
#2: Prevention of obesity c. Summary of Workgroup
#3: Reducing rate of increase of medical costs d. Summary of Workgroup
#5: Increasing system capacity e. Future Commission
meetings: Tuesday, October 23,
1:00-4:00 PM, Montpelier Tuesday, November 20,
1:00-4:00 PM, probably in Montpelier Documents
distributed: a.
Jim Hester: Part of the HCRC responsibility is monitoring implementation of the
legislation; the other major part of the commission’s responsibility is what
comes next: recommendations for future policy. Thus the five work groups. CD
#2, TR 3 The
workgroups are producing discussion draft papers, and holding meetings for feedback
and comment. It is important to understand that these various discussion papers
are discussion drafts: staff analyses of options, putting out what some policy
options are. But these are not official HCRC recommendations. The full
Commission needs to review, discuss, and vote. A
few highlights: In
Workgroup #1, Expanding Affordable Health Coverage: we continue to work with
Ken Thorpe. For
Workgroup #3, controlling Medical Costs: to date, we have produced a series of
smaller documents on various topics. Two themes: Elliot Fisher’s concept of an
“accountable care organization,” the other on long-term care coverage and how
to improve. Workgroup
#4: VITL is working on this, is preparing an initial set pf proposals. (By
the end of October, will have a product from each of the five workgroups. Workgroup
#1 in more detail: Key questions are how to reduce the uninsured population to 4%
by 2010; how to improve the health coverage for the “underinsured” population
and significantly expand the population benefiting from health care reform; and
how to stabilize the individual market. b.
Workgroup #2 in more detail: Don
Dickey: Key points from the Executive summary and slides, which have just been
handed out: Obesity
is a very complex issue. First,
the top three real causes of death in the US are tobacco, obesity, and alcohol consumption. Dickey
reviewed objectives, guiding principles of the workgroup, challenges in
building a comprehensive obesity prevention program; recommended strategies for
state action; components of a comprehensive program; and a summary of
recommended strategies. c.
Workgroup #3 in more detail: Jim
Hester: Will bundle various ideas into a package. Key questions: What one or
two other initiatives hold the greatest promise for reducing the rate of
increase of medical costs while increasing the health of Vermonters? And what
changes could the state make to its administrative and regulatory requirements
which would help reduce overall health care costs? Ideas
include: accountable care organization: a form of payment reform, in the
community health care system overall, including hospital, etc. Make a more
favorable incentive structure. CD
#2, TR 4 d.
Workgroup #5 in more detail: Jim
Hester: A key issue is the capacity in the state to provide services, both
currently and in the future. Part of this is the aging primary care physician
population, and aging in other provider sectors as well. The key question for
the workgroup: What investments do we need to make in Vermont’s health care
delivery system and public health programs to ensure success in health care
reform? Policy
options must address three interconnected questions: 1. How can we ensure
that Vermont has an adequate supply of health care professionals? 2. How do we use technology
or new staffing patterns to leverage the primary care capacity that we do have
to meet the changing health care needs? 3. What changes to the
state’s pubic health infrastructure are needed to improve system performance
and accountability and better meet the needs of the epidemic of chromic
illnesses? e.
Future Commission meetings How
do we put together a package of balanced recommendations for the next session? Given
the scope of these topics, it is important to give this overview and
background. Next
steps: The next Commission meeting is Oct. 23. At the October and November
meetings, the Commission will review and make decisions among the
recommendations of the workgroups. The
meeting adjourned at 4:45 PM. Respectfully
submitted, Loring
Starr |
