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, December 4, 2007 |
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State House, Room 11 |
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Montpelier, 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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Tuesday, December 4, 2007 |
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State House, Room 11 |
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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 12/04/07, CD #1 & 2 |
Documents Distributed: |
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| Witness List: |
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1. Convene, Review and Approve Nov. 20, 2007 Meeting Minutes CD #1, TR. 3 Rep. Maier and Sen. Kitchel convened the Commission meeting at 1:15 PM. The Commission approved the minutes. 2. Implementation Updates CD #1, TR. 4 a. Format of monthly report to legislature Betsy Forrest Documents distributed:
Betsy Forrest discussed the outreach efforts for Green Mountain Care; she presented copies of a PowerPoint overview of the programs that is also available on the Green Mountain Care website. http://www.greenmountaincare.org/outreach_center/outreach_toolkit.html Q: When legislators get calls and questions re the new programs, who should they contact? A: Betsy will take those calls for now. Betsy gave an update on applications and enrollment. Betsy then presented the Draft reports format.
Betsy gave a brief overview of this draft template, and asked commissioners to review and comment back. It combines several reports; and also gives the ability to compare results back to projections. Report areas include:
o Enrollment detail o Per-member-per-month state expenditures o Total program expenditures o Total other expenditures o Total revenues o Deficit/Surplus
o Total enrollments by month, by various programs o Demographic analysis of enrollees, by program (income, age, gender, county) o Range & Type of ESI Plans (deductibles, premium, employee’s share, employer percentage) They anticipate providing their first combined report with data in mid January. Q: Have they seen much negative feedback from employers re the new information? A: They sent out about 6,000 notices to employers; have had only 4 or 5 complaints. They have received about 1,700 forms back from employers to date. 3. Commission Recommendations CD #1, Tr. 5 Jim Hester, Hans Kastensmith Document distributed:
3.a. Quick update on Health IT Hans Kastensmith There has been some restructuring under the new Blueprint Director, Craig Jones. They are addressing some of the systems questions. Hans believes that the result will be very acceptable to the provider community. Also, there is a strengthening of programmatic chronic care model. Dr. Jones is providing clear leadership. Hans gave a correction to the Recommendations, Workgroup 4, section d., pg. 9: the data are 122 practices, about 300 providers. Also, a clarification re “state revenues”. When we say estimated costs from “state revenues”—it is more accurate to say “state-sponsored,” to clarify that they do not expect entire funding to come from state revenues. Finally, re E-prescribing: this is still under discussion and review. Q: What are the reactions from the providers, re indemnifying VITL--Is there buy-in on this from the State Medical Society, re proposals re liability? A: Paul Harrington, Vt. Medical Society: This deals with VITL’s liability; as long as VITL is not shifting liability to providers, they do not have a problem with this. No problem with indemnifying VITL re its responsibilities re data. CD #1, Tr. 6 Paul Forlenza, VITL: A clarification re E-Prescribing: VITL needs to review this issue. They have concerns re costs. This will be part of VITL’s project review process. 3.b. Discussion of Revisions to Recommendations CD #1, Tr. 7 Jim Hester Documents distributed:
Jim will first review the summary of major changes since the November Commission meeting. There was discussion of the process for this meeting: S. Maier: The commission will vote today, to set priorities and recommend the best ideas for next steps in health care reform. Clearly, some of the more difficult decisions will be the work of the various policy committees, during the session. Our vote today is to pass along our review of the best set of ideas so far. REVIEW OF RECOMMENDATIONS [Please see attachment: Summary of Major Changes to 11/20/07 Draft] I. Jim reviewed the edits in the introduction: o Clarified the strategic context for the recommendations o Acknowledged the significance of the ongoing challenge to reduce the rate of increase of medical costs Then he discussed the most significant changes to the recommendations, section by section. II. Recommendations A. Expand Affordable Coverage to More Vermonters Under-insured · Added requirement that one of the benefit design options be equivalent to Catamount Health · Dropped estimate of range of savings from the wellness disease management programs · Dropped reduction in provider payments as an approach to reducing premiums · Added cost estimate for broader use of Section 125 plans: approximately $1 million/yr for 10,000 people Uninsured: No changes Discussion: in previous drafts, there were references to problems in the individual market. They are not in this draft, there has been a request to put them back in. EDIT: On page 4, add a new paragraph 3: 3. Stabilize the individual market. BISHCA and Blue Cross Blue Shield of Vermont will be proposing specific changes based on Elliot Wicks’ study and other input. Jim continued with the summary of major changes to the recommendations. B. Improve the Prevention of Chronic Illness by Reducing Obesity o Clarified lead role of Vermont Department of Public Health C. Reduce rate of increase in costs while improving the health of Vermonters o Control hospital budgets: Added consideration of elements of H304 such as hospital global budgets and restructuring of financing o Changes in state administrative and regulatory requirements: Added Vermont Medical Society support for legislation that establishes Fair Trade Standards for Health Insurance Companies D. Use IT as a catalyst for reform o Revised language about the assessment of Electronic prescribing o Clarified VITL legislation language E. What investments do we need to make in the capacity of Vermont’s health care delivery system to ensure success in health care reform? o Clarified language regarding enhanced oversight of changes in licensing and professional scope of practice and the criteria used in the process Those are the significant and substantive changes to the previous draft. 3.b. Continued: Discussion of revisions CD #1, Tr. 8
The commissioners then went back to the beginning and discussed the recommendations in detail. I. Introduction Discussion, re third paragraph. EDIT: Paragraph 3, line 5, change “action” to “consideration”. II. Recommendations EDIT: for all the sections and workgroups, take out the subtitles “Workgroup 1,” etc. These are no longer workgroups—they will now be the recommendations from the commission itself. A. Expand Affordable Coverage to More Vermonters Discussion: Are all commissioners OK with the earlier suggestion re adding in a new section— 3. Stabilize the individual market. BISHCA and Blue Cross Blue Shield of Vermont will be proposing specific changes based on Elliot Wicks’ study and other input. EDIT: Yes. CD #2, Tr. 1 Discussion: Section A. 1. a: In the second sentence, “Benefit packages…”, change the text to: “For example, benefit packages could be modeled on small group offerings and one benefit option should be comparable to the benefit design of Catamount Health.” Discussion: Section A. 1. a. ii: Page 3, text 3 lines above the table: this is very prescriptive; also concerns re the 70%. EDIT: change that sentence to read: “Employers offering the HealthyVT product should pay a part of the premium costs and would collaborate in encouraging their employees to complete Health Risk Appraisals and participate in the wellness programs.” Discussion: Section A. 1. c., page 4: EDIT: Delete the entire paragraph under c. and replace with: “c. Explore providing post-divorce coverage for families (S.62).” Discussion: Section A. 1. d., page 4: EDIT: Insert the word “Reduce” before “Cost Shift.” EDIT: Delete the final 2 sentences under d. and replace with: “The Commission also recognizes the importance of reducing the cost shift over time.” B. Improve the Prevention of Chronic Illness by Reducing Obesity There were no changes to this section. C. Reduce rate of increase in costs while improving the health of Vermonters EDIT: Section C. 2: Change title to “Control hospital costs”. There was discussion of sections C.2.b. and C. 4., no changes were made. D. Use IT as a catalyst for reform Commissioners corrected the data under D.1.a. i. It should read: i. ~ 320 physicians in 120 non-hospital primary care practices that do not have EMR E. What investments do we need to make in the capacity of Vermont’s health care delivery system to ensure success in health care reform? Discussion of scope of practice; discussion of E.1.; no changes made. 3.c. Vote on Recommendations CD #2, Tr. 2 Motion, Sen. Racine: Move that the Commission approve the report in front of us as amended this afternoon. Second: Sen. Cummings. Rep. McFaun thanked Jim Hester and all the staff, and all those who worled on these recommendations. Vote: All in favor: Unanimous. No opposed. No abstain. 3.d. Follow-up process CD #2, Tr. 3 Jim Hester i. Drafting legislation ii. Coordination of legislative committees Drafting legislation: The legislative council staff will work with the Commission chairs and Jim to draft legislation per these recommendations. Coordination of legislative committees: The committee chairs of the respective committees of jurisdiction are consulting with the staff. 4. Next commission meeting: After legislature reconvenes Jim Hester Generally, the Commission meets on an as-needed basis during the session, less often than monthly. The meeting adjourned at 3:15 PM. Respectfully submitted, Loring Starr |
| Next page: Appendix: Summary of Major Changes to 11/20/07 Draft |
