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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Tuesday, November 20, 2007 |
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State House, Room 10 |
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Montpelier, VT |
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115 State Street |
|
SEN. M. JANE KITCHEL, CO-CHAIR
|
STATE OF VERMONT |
|
|
GENERAL ASSEMBLY |
||
COMMISSION ON HEALTH CARE REFORM |
||
MINUTES |
||
Tuesday, November 20, 2007 |
||
State House, Room 10 |
||
Montpelier, VT |
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MEMBERS PRESENT: | SEN. M. JANE KITCHEL, CO-CHAIR, REP. STEVEN MAIER, CO-CHAIR, SEN. ANN CUMMINGS, SEN. KEVIN MULLIN, SEN. DOUG RACINE, REP. HARRY CHEN (via phone), REP. FRANCIS MCFAUN, JOHN BLOOMER, JR., REP. MARK LARSON, WALTER FREED |
MEMBERS ABSENT: |
None. |
Also Present: |
Legislative and Joint Fiscal staff, members of the Administration, and the public. |
Meeting Recorded: |
Meeting recorded: CD HCRC 11/20/07, CD #1, 2 & 3 |
Documents Distributed: |
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| Witness List: |
From Testimony Section |
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1. Convene, Review and Approve Oct. 23, 2007 Meeting Minutes CD #1, TR 1 Rep. Maier and Sen. Kitchel convened the Commission meeting at 1:15 PM. The Commission approved the minutes. 2. Implementation Updates a. Catamount Health implementation 10/1 Susan Besio Documents distributed:
Susan Besio reviewed call volumes at the Green Mountain Care Call center. Significant increase in calls and web site visits since public relations roll-out in early November. There have been a few situations of adverse reactions from employers. They are monitoring and following up as needed. Also developing a fact sheet on employer responsibilities and employee rights. Will distribute every way they can. Update re regional trainings: trainings will continue this fall, at all the hospitals. High-level information, re eligibility, call numbers, screening tools and web site. The Green Mountain Care web site has a high-level screening tool, and downloadable application forms, including applications for full-pay Catamount Health, possible premium assistance for Catamount Health and other programs such as VHAP and Medicaid. There is also a downloadable PowerPoint presentation on Green Mountain Care: http://www.greenmountaincare.org/outreach_center/outreach_toolkit.html Staff are screening all applicants for all programs. There was a discussion of the number of hits to web site, applicants, enrollees to date. Concerns raised re people falling off employers’ plans because of more recent rate increases—might it even offset or overwhelm new sign-ups? Susan Besio also went through the list of reports that the legislation requires from the Administration, discussed deadlines, etc. Starting in January, they will probably be presenting consolidated reports in several areas. 3. Commission Recommendations CD #1, Tr. 2 Jim Hester Document distributed:
[See Appendix A to these Minutes] Jim Hester acknowledged the great time and effort from volunteers that has gone into these draft recommendations, as well as the staff time. Today will be a quick review of all the recommendations, but there will not be time for an in-depth discussion of each one. Introduction: Comment: Needs a statement saying that we have real sustainability problems, especially as health care costs continue to rise. Jim explained the process: he will do a revised draft after today, after reviewing testimony and responses, and will circulate it next week. Jim continued to review all the draft recommendations. 3.a. Workgroup #1, Expand Affordable Coverage CD #1, Tr. 3 Jim Hester and Ken Thorpe .Key recommendation is A.1.a.: Improve the health coverage for the ‘underinsured’ population and significantly expand the population benefiting from health care reform. Create a new health coverage option offered to small employers and individuals who currently have health insurance (working name is HealthyVT). Benefit package(s)would be modeled on small group offerings. Q: Re Rhode Island Plan and community rating. A: Jim will research and report back. Q: Any discussion of funding sources? A: There are funding issues throughout the recommendations. CD #2, tr. 1 Discussion of actual projected savings, and uncompensated care; and segmenting employment by occupation, rather than by number of employees. Workgroup #1, item #2. “2. Make better progress towards the goal of having only 4% of Vermonters uninsured by the end of 2010.” a. Expand participation in existing Catamount Health product i. Reduce waiting period to six months: 15% increase in eligible pool, new enrollees (3,000) and cost to state ($5 million) by 2010 ii. Add financial hardship category to list of exceptions: criteria include loss of insurance coverage within the last three months due to a ‘qualifying event’, income < 300%, medical expenses greater than X% of income. b. Implement automatic eligibility for VHAP and Medicaid eligibles who have incomes low enough that they pay no premium i. Impact: 10,000 people ii. Costs are difficult to estimate, but we have assumed that, in general, this group will use less services than those currently enrolled. An approximate estimate is a total cost of $26 million/yr, with the state’s share being $10.5 million/yr iii. Issue: it is not clear exactly how to implement this provision. Unlike some other states like Massachusetts, Vermont has no data base which identifies exactly who these individuals are and how to contact them. c. Provide coverage for young adults under their parent’s policies through age 26 regardless of college enrollment. Impact: 16,000 uninsured were 18-26 years old in 2005 25% = 4,000 Cost: a small (approximately 1%) increase in commercial premiums.
3.b. Workgroup #2, Prevention of obesity CD #2, Tr. 3 Jim Hester and Don Dickey Jim Hester: Don has had strong support from the Vermont Department of Health, including leadership and staff, and from a wide range of other stakeholders. The timing is right for a major initiative in this area. 3. c. Workgroup #3, Controlling Medical Costs CD #2, Tr. 4 Jim Hester There are four key recommendations in this area:
Discussion followed re idea of “community-based global budget”. Need to start by clearly defining the real population being served. Then negotiation between provider organizations and payers—perhaps create a target budget per person for the next year. Then track and manage expenditures. If there are savings at the end of the year, could invest them in the community; if no savings, or a deficit, perhaps some kind of risk sharing. These ideas will need to be developed further. Discussion of possible pilots, specialist procedures across regions, challenges in defining a medical home, etc.
3. d. Workgroup #4, Health Care IT CD #2, Tr. 5 Jim Hester Major recommendation: build on VITL’s program on Electronic Medical Records (EMR’s): Accelerate the successful implementation of Electronic Medical Records, particularly in smaller, primary care practices that are not hospital owned, by expanding VITL’s EMR pilot program. Other recommendations in this area include Electronic prescribing (e-Rx) and VITL legislation: clarify and enhance VITL’s role in planning and supporting the implementation of key health IT infrastructure in the state. 3. e. Workgroup #5, 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? Jim Hester CD #2, Tr. 6 These recommendations cover three areas: recruiting and maintaining healthcare staff, leveraging existing professional capacity with technological tools or new staffing patterns, and enhancing “system-ness” and accountability within the public health infrastructure.
Jim said that overall, this has been a very rewarding and productive process. 4. Public Testimony CD #3 Tr. 1 Documents distributed:
John Block CD #3 Tr. 1 Deborah Richter CD #3 Tr. 2 Con Hogan CD #3 Tr. 3 Richard Davis CD #3 Tr. 4 Nancy Potak CD #3 Tr. 5 Marge Power CD #3 Tr. 6 Stefanie Sidortsova CD #3 Tr. 7 Lynette Courtney CD #3 Tr. 8 Mary Alice Bisbee CD #3 Tr. 9 Paul Harrington CD #3 Tr. 10 Andrea Cohen CD #3 Tr. 11 Ken Eardley CD #3 Tr. 12 Dorothy Reilly CD #3 Tr. 13 The meeting adjourned at 4:25 PM. Respectfully submitted, Loring Starr |
