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1.  Convened at 1:10 PM

Minutes from 9/23 approved.

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2:  Progress Report on Prevention Programs

2.a. Prenvention Progress

Don Dickey, consultant to the Commission

 

Documents distributed:

Doc. #1: Act 203, Selected Sections

Doc. #2:  Act 203, Healthy Lifestyle Sections, Overview

Doc. #3: Diagram: Fit and Healthy Vermonters Initiative (Physical activity and nutrition)

Doc. #4: PowerPoint from Vt. Dept. of Health, Act. 203

 

Don Dickey gave an overview of the legislation and the charge to the Department of Health (DOH).

 

2.b. Vermont Dept. of Health implementation of Act 203

     Wendy Davis MD, Commissioner, Vermont Dept. of Health 

 

Documents distributed:

Doc. #5: CHAMPPS grants

Doc. #6: Model for health and Prevention

Doc. #7: Executive Summary: Vermont’s Strategic Prevention Framework, State Initiative Grant

Doc. #8:  Vermont 2008 and 2009 Tobacco Control work plan

Doc. #9: Myth Vs. Reality: Nutrition labeling at Fast-food and other Chain Restaurants

 

 

Commissioner Davis reviewed Act. 203, Section 13, Community Plans.

 

Q: How effective will the part-time community specialists be? Do they have too much work?

A:  This will be a challenge; we will see as it plays out. She understands the concerns, we will see how it develops.

 

Q: Staff for the Middlebury district?

A: There are position challenges: The DOH does not have a position to offer. There is a strong district director in Addison County. The DOH has hired a specialist for the St. Johnsbury area.

 

Discussion continued re the missing position. The Commission will need to know soon re next steps to build capacity for prevention in Middlebury.

 

Discussion of overall impact of the state budget cuts on all areas of state government; discussion of training for the prevention specialists.

 

List of CHAMPPS Grants: total of $518,000 so far.

 

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2.c. Community activation in the Blueprint for Health

     Craig Jones MD, Director of the Blueprint for Health 

 

Documents distributed:

Doc. #10: Blueprint Pilot: Health Care Transformation

Doc. #11:  Blueprint Integrated Pilot Program: A Systematic and Integrated Approach to Prevention (also in a PowerPoint)

 

Dr Jones presented a report on the Blueprint Integrated Pilot Program: A Systematic and Integrated Approach to Prevention.

 

Q: Regarding the state’s Reduction in force, what parts of this may not be able to be done?

A: Referring to the slide in pg. 5, Community Activation and Prevention, Current Status: you can see the areas where activities are not being done yet—these will probably not get done.

 

Q from Rep. Maier: He would like a clear statement on how this work is going to get done in every community—perhaps at the December HCFRC meeting.

 

Q from Senator Mullin: He would also like an update on the progress on counter-detailing.

 

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Discussion continued.

Re prevention specialists working with care teams: Dr. Jones: the community care team is a core resource. It gives capacity to carry out various interventions. One goal: come up with a practical, do-able prevention strategy.

 

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3.        Health Care Reform Implementation

 

3.a. Regional strategy for CMS support of medical homes

     Craig Jones MD, Director of the Blueprint for Health 

 

Background: Medicare so far is not participating—we are currently subsidizing Medicare in Vermont.

One month ago, the Brookings Institution held a meeting—gathering states and Medicare to see how the federal government could support these kinds of health care reform. Communication with CMS people was difficult.

Dr. Jones also discussed Medicare demonstration projects overall.

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3.b.     BISHCA update on rules and all-payer database

     Christine Oliver, Deputy Director for Health Care, BISHCA 

 

Document distributed:

Doc. #12: Status Report—Nov. 6, 2008—Vermont Healthcare Claims uniform Reporting and Evaluation System (VCURES)

 

VCURES is a consolidated database of eligibility and medical and pharmacy claims records related to health care provided to Vermont residents regardless of where care is rendered and by Vermont health care providers and facilities for non-residents.

 

The Vermont Department of Banking, Insurance, Securities and Health Care Administration (BISHCA) administers VCURES, formerly referred to as the Multipayer Claims Database, as a resource for reviewing health care utilization, expenditures and performance in Vermont.

 

Commissioner Oliver discussed the collaborative process regarding the data for VCURES.

 

Re the Certificate of Need (C.O.N.) revised rule: BISHCA expects to file the rule in December.

 

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4.        Revised Commission Statement on Health Care Costs

     Steve Kappel, Consultant to the Commission 

     Don Dickey, Consultant to the Commission 

 

Document distributed:

Doc. #13: Draft commission statement on unsustainable health care cost trends

 

Don Dickey explained the comments process; there is a lengthy document of 33 pages of all the comments received to date—this is available on request.

 

Don reviewed the latest changes in the draft.

·    Cost shift, pg. 4: impact on those paying for cost shift now.

·    Pg. 4-5: Two would-be solutions that would be difficult to do; “high-performing networks;” medical technology as a major cost driver.

·    Bottom of pg. 6: added section on political barriers. Need to rephrase statement re “The impact of legal and political barriers…”

·    Pg. 8:  language re “major investment of time and resources…”

·    Pg. 9: Government regulation as another area of administrative simplification

·    Made some changes to Conclusions

 

Chair Rep. Maier: Commissioners please review these recent changes; Don will make further changes; please be prepared to review again and vote at Dec. meeting.

 

Sen. Racine: This document is very effective; we need to decide how to disseminate this widely and effectively.

 

Don: Steve Kappel is also working on the document on cost drivers and the cost shift.

 

Rep. Chen: We should put this all together in a binder as a resource, as well; further discussion: HCRC should also prepare an electronic version of the binder.

 

Rep. McFaun: concerns that we are drawing some conclusions that we cannot back up?

Further comments on the Single Payer section.

 

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5.        Staff Update: Commission Studies for 2008-09

     Jim Hester, Director of the Health Care Reform Commission 

 

Document distributed:

Doc. #14: HCRC Summer work Plan, Update for 11/6/08

 

1.  The public financing study:

From Act 203:

“This study will expand upon the completed financing analysis called for in Sec. 277d of No. 215 of the Acts of the 2005 Adj. Sess. (2006) to create a common analytic basis for policy decisions on the public financing of health care, explore broad-based revenue sources, identify and assess major federal issues with public financing, and analyze the impact of different financing options on the underlying cost drivers in health care. 

A list of questions for this study has been circulated broadly. A work group is being formed. Consultant Steve Kappel is soliciting input re the questions and the components to review; he is also working on a baseline analysis on what the level of public financing currently is—where we are now.

Steve hopes to have a first cut ready for the Dec. HCRC meeting.

 

2.  Accountable Care Organization (ACO) Feasibility study:

Feasibility of a pilot in community-based payment reform and integration of care, including the model of an ACO. The commission has contracted with KNG Health Consulting, LLC to facilitate this study. A work group is meeting; they and consultants are reviewing a number of working papers; and discussing options and challenges.

 

3.  The study on merging risk pools:

Assessment of options for merging risk pools starting in January 2010.

The Commission has contracted with Elliott Wicks; he is working on a draft study, which the Commission will review and circulate for responses.

 

4.  The e-Prescribing study:

A study on the costs and benefits of electronic prescribing.

The Commission has contracted with Point of Care Partners for this study. They are beginning their work; a commission work group is meeting; work is under way. The group is conferring via “Webinar,” with the help of VITL; this seems to be working well.

 

There is also a group working on nursing capacity and nursing faculty capacity. A letter from the health committee chairs got this started last spring. The State Colleges say this will require additional funding, and they got funding cuts instead.

 

Commissioners would also like a report on the leaders’ trip to DC in December;

 

There is also a NLARx meeting in December; we need more of the six appointed Vermont legislators to participate.

 

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6.        Commission meeting schedule and agenda: December in Montpelier

 

How about Tuesday Dec. 2 instead of Dec. 3? Commissioners who were present agreed.

Meeting will be Dec. 2, 1-4 PM.

 

The meeting adjourned at 3:25 PM.

 

Respectfully submitted,

Loring Starr