COMMISSION ON HEALTH CARE REFORM

MINUTES

Tuesday, November 15, 2005

 

 

 

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

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

 

Members Absent:      Senator Ann Cummings

 

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

                                       Administration, the press, and the public

 

Meeting Recorded:   CD 2005 – 15,16,17

 

1.       Convene, Review, and Approve 10/10/05 Meeting Minutes

Senator Leddy and Representative Tracy convened the meeting at 9:55 a.m. in Room 10 at the State House, Montpelier, Vermont.  Senator Leddy asked for a motion to accept the 10/10/05 meeting minutes as presented.  A motion was made and seconded.  The motion passed unanimously on a voice vote.

 

2.       Presentation on Health Care and Discussion - Chronic Care Management:  Options for Vermont       

Documents distributed:

 

Kenneth E. Thorpe, Ph.D., Consultant to Commission, presented a power point presentation on chronic care management.  He said the key facts were: the cost of treating chronically ill patients accounts for 75% of health spending in Vermont; the rise in chronic illnesses and obesity is a key factor in driving growth in spending; chronically ill patients receive about 50% of the clinically recommended care; and how services are delivered needs to be restructured so that the patient is the focus; it is an integrated multidisciplinary approach; it is a proactive, not reactive, model.

In response to a question from Representative Maier, Dr. Thorpe said the chronic care model will not necessarily save a lot of money unless it is designed to do so.  It would, however, be a better value.  He said the challenge was to gain full implementation.  Representative Maier requested Dr. Thorpe outline what it would take, specifically, for implementation to be on the fast track and then what requires legislation.

 

Representative Mullin asked if Dr. Thorpe had assessed the Vermont Blueprint for Health.  Dr. Thorpe said the challenge is to examine two key issues to ascertain if the model is successful:  how it is integrated, if it is seamless; and how services are paid for.

 

Walter Freed asked that possible pitfalls due to change be looked at as well as possible successes.

 

John Bloomer asked how to get everyone involved and part of the program if ERISA is exempting 50% of the population.  Dr. Thorpe responded that the program did not have to be mandated, but offered statewide from a public health and primary prevention point of view.

 

Senator Leddy asked Dr. Thorpe to look at the successful disease management which has saved the state employees money and allowed a premium holiday.

 

Senator Kitchel asked about the amount of time it would take to implement the program, given the state has been working on it for five years.  Dr. Thorpe said buy-in was needed, and how the system is integrated and how seamlessly were part of the implementation challenges.

3.       Presentation on Health Care and Discussion - Potential Role of Automated Patient Safety Reporting Systems in Vermont Hospitals

Documents distributed:

 

Kenneth E. Thorpe, Ph.D., Consultant to the Commission, presented a power point discussion of the potential role of automated patient safety reporting systems in Vermont hospitals.  He said there is a major opportunity due to the fact that 50% of the $17 - $29 billion national cost associated with medical errors is preventable; the key to long-term success is in establishing a safety management program which is leadership driven, data-based, multidisciplinary, enterprise wide, multifaceted and has a foundation for all improvement initiatives.

 

Commission members discussed who would keep the savings and how they would be shared and distributed in the system.

 

Dr. Thorpe said the challenge was to have population-based public health initiatives using the chronic care model to facilitate reducing the clinical administrative costs of the system.

 

The Commission recessed for lunch and reconvened at approximately 1:15 p.m.

4.       Work Plan and Discussion

Documents distributed:

 

 

Catherine Benham, Staff Director, Commission on Health Care Reform, distributed a proposed Commission work plan which outlined the short-term and the long-term goals.

 

Senator Leddy distributed a letter from Herb Olson, BISHCA, to Senator Leddy and Representative Tracy in response to Senator Leddy’s request for an outline of a proposed work plan from governance and administrative study. 

 

Senator Leddy also distributed the Governor’s “Consensus Legislation” outline, emphasizing it was the Administration’s proposal and had not been accepted as consensus. Senator Leddy and Representative Tracy are continuing to meet with the Administration for discussions.

 

John Bloomer requested Dr. Thorpe present how other states finance the chronic care model and its costs.  He also asked for more detail on how it could work.

 

Representative Maier asked for an evaluation of the current chronic care initiative and what it would take to be a “fast track” state.

 

Senator Kitchel said the quality of the implementation was important and asked what Vermont needs in terms of resources and what is missing.

 

Representative Ancel requested Dr. Thorpe suggest what the specific legislative role is.  She also requested a side-by-side comparison of all of the health plan proposals submitted to the legislature and the governor’s health summit.

 

Walter Freed stated that the legislature will need a concrete package of specific actions.  What are these and how do they affect health care spending?

 

 

 

Senator Mullin requested the consensus plan presented by the Administration be assessed in term of performance measures, analyzed for what increased reimbursement for performance would mean, and how behaviors would change.

 

 

Dr. Thorpe reviewed the studies that are due in January.  He has reviewed the proposals from the Governor’s summit as well as others.  Two pieces look at a health care package that would be universal and a general insurance proposal.  In general, proposals fall into three categories:

 

  1. Individual mandates –everyone is required to have insurance.  Different ways to finance – who pays what? State, employers, individuals.  Based on income?
  2. Employers provide coverage – if you are between jobs, you still need to have insurance. 
  3. Medicare for all approach – dedicated source of funding and the state pays for a defined set of services, and people do not pay premiums.

 

Dr. Thorpe will include specific financing options and, for each proposal, will examine the pros and cons and the impact on employers and individuals and the state.  The comparison will be both distributional as well as the total state cost impact.

 

Representative McFaun asked if there is a model of care whereby hospitals provide services, the state picks up catastrophic care, and primary care is provided by insurance. 

 

Kenneth E. Thorpe, Ph.D., Consultant to Commission, and Paul Harrington, Director, Vermont Medical Society, commented.

 

 

Senator Leddy said Representative Tracy and he, with the Administration, were going to have future discussions about the Administration’s consensus plan and look at ideas and issues and find as much common ground as possible.

5.       Request for Proposals for Health Care Information Systems in Vermont

Documents distributed:

 

Catherine Benham, Staff Director, Commission on Health Care Reform, distributed the request for proposals to evaluate the current state of health care information technology in Vermont, for which she had solicited input from Commission members prior to issuing.   

 

Kenneth E. Thorpe, Ph.D., Consultant to Commission, and Beatrice Grause, Vermont Association of Hospitals and Health Systems, commented.  Beatrice Grause said there was already work being done which might be updated.

 

The decision process for choosing a proposal will be the following:  a group (including  Catherine Benham, Steve Kappel, Steve Klein, Rich Reed, and Ken Thorpe) will make a recommendation to the co-chairs who will make a final decision after getting input from both the Speaker and the President Pro-Tem.

6.       Joint Health Committee Public Engagement Process Update

Senator Leddy updated the Commission on the successful completion of six health care public engagement days which took place throughout the state.

7.       Medicaid Global Commitment Update

 

Representative Martha Health, Chair, House Appropriations Committee; Representative, Westford, updated the Commission on the status of Medicaid Global Commitment and that the Joint Fiscal Committee was proceeding.  The Joint Fiscal Committee approved Global Commitment contingent upon several conditions being met prior to full approval.   The next Joint Fiscal Committee meeting is scheduled for November 17th.

 

Senator Kitchel requested the Commission be updated regarding decisions the Health Access Oversight Committee makes on Medicaid Global Commitment.

8.       Future Meeting Planning

The Commission agreed to meet Friday, December 16, in Room 11, State House Montpelier.  Commission members also discussed a possible Thursday, January 12 or Friday, January 13 meeting.

 

The meeting adjourned at 2:35 p.m.

Respectfully submitted,

/s/ Rachel Levin, Legislative Council

/s/ Catherine Benham, Staff Director