COMMISSION ON HEALTH CARE REFORM

MINUTES

Tuesday, October 10, 2005

Members Present:  Representatives John Tracy, Co-chair; Steve Maier; Janet Ancel; Francis “Topper” McFaun; Senators Jim Leddy,

                                    Co-chair; Ann Cummings; Jane Kitchel; Kevin Mullin; John Bloomer, Jr.; Walter Freed.

Also Present:          Legislative and Joint Fiscal staff, members of the

                                    Administration, the press, and the public

Meeting Recorded:CD 2005 – 11, 12, 13, 14

1.       Convene Review and Approve 9/20/05 Meeting Minutes

Senator Leddy and Representative Tracy convened the meeting at 10:00 a.m. in Room 11 at the State House, Montpelier, Vermont.  Senator Leddy asked for a motion to accept the 9/20/05 meeting minutes as presented.  Representative Maier made a motion, and Senator Kitchel seconded the motion, to approve the 9/20/05 meeting minutes as presented.  The motion passed unanimously on a voice vote.

2.       Commission Process Update     Presentation on Health Care and on Proposed Work Plan

Catherine Benham, Staff Director and Joint Fiscal Office and Dr. Ken Thorpe, Consultant, Commission on Health Care Reform  

Catherine Benham provided an overview of the schedule for the next two days including the various meetings scheduled for Dr. Thorpe while he is in Vermont.

Documents distributed:

• “Future Directions for Health Care Reform in Vermont” presentation by Dr. Kenneth Earl Thorpe

Dr. Thorpe presented information on chronic illness, associated health costs, obesity, opportunities for better management of chronic diseases, improvement of the system by reducing medical errors/events and possible options for examining the financial and economic impacts of some health care reform proposals.  

Chronic Care:

In 2006 Medicare is going to have to provide disease management, and this can be viewed as an opportunity to start this concept with other populations.  Focusing on state programs, such as Medicaid and perhaps state employees, provides an opportunity to develop model programs and also avoids ERISA issues.  There are studies that show there is a return on investment for treating chronic conditions, but this return depends on having good structure and management of the program.

Key components of this chronic care initiative are its focus on conditions with proven clinical treatment and changing the payment structure as an incentive for providers.

Dr. Thorpe also answered questions about European countries and what they are doing, obesity rates and chronic conditions, and competition.  He provided examples of other states and companies that have implemented some of these changes with positive results. 

The commission took a break for lunch at 12:20 pm.

The commission reconvened at 1:25 pm.

The Commission agreed to meet Tuesday November15 in Room 10, and Friday December 16, State House Montpelier at 9:30 am. 

Senator Leddy wanted to make it clear that Dr. Thorpe is available to talk with any interested member of the commission.  Please contact Catherine and she will arrange it.

IT Systems

Dr. Thorpe discussed opportunities to reduce medical events and errors through IT systems and how these have been successfully implemented in various hospitals across the U.S.

For January 15 reports, Dr. Thorpe discussed the option of having him look at the financing impacts on many levels including the impact on households and on the economy.  He also suggested that he could pick specific taxes or general prototypes to study these impacts. 

The commission requested that the health plan presentations from the Governor’s summit be sent to Dr. Thorpe along with other available plans.

Senator Bloomer raised the issue of also examining any proposal’s impact on immigration to Vermont by people needing/wanting medical care and on doctor recruitment.

Dr Thorpe was asked to look at the current efforts underway in the Vermont Blueprint for Health and on health care IT to see if these efforts are heading in the right direction.  He will also lay out key design features of effective chronic care and IT systems.

Representative Freed summarized that this is a new approach.  We need to show how you can control costs now by focusing on cost drivers.  We should grab the population we have control over and work on them to implement these changes and see how they work.  This would to provide a road map instead of mandating changes.

3.       Medicaid Global Commitment Update, Steve Kappel, Joint Fiscal Office   Robin Lunge, Legislative Counsel  

Documents distributed:

• Joint Fiscal Committee 9/30/05 motion to approve with amendments the recommendation of the health access oversight committee to grant contingent approval of the Global Commitment to Health Demonstration Waiver Program.

Steve Kappel, Joint Fiscal Office, updated the commission on the status of global commitment and briefly summarized the concepts.  He then presented the motion that was passed by the Joint Fiscal Committee.  Robin Lunge, Legislative Council, and Steve explained various provisions and answered questions. 

4.       Joint Health Committee Public Engagement Process Update

Senator Leddy discussed the first public forum of the Joint Health Committee, comprised of the House Health Care and the Senate Health and Welfare Committees.  He reminded people that the next event is October 11 in Rutland.

The meeting adjourned at 3:15 p.m.

Respectfully submitted,

/s/ Catherine Benham, Staff Director