by Tom Huebner, Chair of the Board, Vermont Care Organization (VCO) and CEO and President of Rutland Regional Medical Center In October, Vermont leaders signed an historic agreement with leaders from the federal Centers for Medicare and Medicaid Services (CMS) in Washington to create a new model for delivery, evaluation and reimbursement of healthcare services and providers in Vermont.
Experts noted that Vermont is the first state in the US to fully adopt what’s called an “All-Payer Model” (APM) for health care providers, a system that focuses on keeping people healthy.
CMS called the Vermont model “historic in terms of its scope, aiming to include almost all providers and people throughout the state in an all-payer Accountable Care Organization (ACO) model to drive improved quality, better care coordination, healthier people and smarter spending. “
Vermont leaders talked about the benefits of a model that supports providers as they work together to improve quality, access and patient satisfaction, in ways that better manage costs.
While most assessments were positive, questions and concerns were also expressed, which is to be expected. Any new approach can be unsettling and there are many questions we will all answer together over time. The confusion that exists is normal given that all of this is very new to all of us, including those of us who have worked in healthcare for decades.
It was only ten years ago that the term “Accountable Care Organizations” was debuted by Medicare. Then, before we fully understood the nuances of ACOs, along came “Next Generation” ACOs and the All-Payer Model … a whole new flock of acronyms for providers and patients to learn about.
The speed at which things have moved reflects the commitment of CMS and the medical community to change way healthcare is provided so that it focuses on quality, access and patient service as the essential foundation for reining in runaway healthcare costs sensibly and effectively in ways that are patient focused and led and managed by physicians and people who work in healthcare.
The Vermont Care Organization (VCO) has been created to be such an organization, an ACO. In fact, we hope to be the single Accountable Care Organization for Vermont. As we talk with folks, we are being asked for some very basic information, often starting with the key question: Who are you guys? Who’s really running your organization? The answer is – we are, your local healthcare providers.
Our statewide network – in every Vermont county – is comprised of doctors, nurses, primary care clinics, hospitals, agencies working in home health, mental health care and substance use treatment, and rehabilitation, plus community-based human service organizations and much more.
We have united voluntarily to work together to create a new and better state of health for Vermonters.
Our board has 21 members including five physicians, representatives from four hospitals (critical access, community and large referral hospitals) and two Federally Qualified Health Centers, with strong involvement of primary care providers. We also have board members representing home health care, mental health and substance abuse treatment, social services and long-term care. We are now seeking to appoint members from the business community and three consumer representatives, and there are two at-large representatives.
This board composition was thoughtfully created to ensure that we represent all parts of the state, and are broadly representative of healthcare and Vermont consumers, never dominated by any one sector or any one provider.
In our discussions, we reassure people that the VCO is not a government body, nor a group of bureaucrats who are telling doctors and caregivers what to do. VCO is your doctors and caregivers, and we will lead the decisions about how to create a healthcare system for Vermonters that meets two goals: better health and better healthcare.
We also want people to understand that we are still a work in progress. While we’ve been planning for this moment for more than two years, the All-Payer Model agreement was just signed two weeks ago. It sets the stage for your doctors and healthcare providers – the VCO – to begin our work in earnest. There are many details still to be resolved, much work still to be done. We are excited to be taking on this challenge. We entirely believe the APM provides the best structure for improving care for Vermonters. This is a great opportunity!
We want to talk more with Vermonters about how we will work to ensure that when people are sick or hurt, they will get the quality care and service they need in the most accessible way, AND when they are healthy, they get the support and tools they need to stay healthy.
In the coming months, we will be seeking out conversations with citizens across the state, and sharing information and ideas via articles like this and other channels. We look forward to talking with you, to setting up presentations, and answering questions. Feel free to send me questions at [email protected], and we’ll do our best to get answers back to you. Working together, we can make a new healthcare system that is better for all of us!
Tom Huebner
Chair of the Board
Vermont Care Organization
CEO and President
Rutland Regional Medical Center
160 Allen Street
Rutland, Vermont 05701