Last week I attended a unique healthcare meeting in Stowe, Vermont. I was there to get a better feel for the mind of clinical leadership at a moment of great transition in the state. The subject that was at the core of the conference was the future of care in Vermont. I think that someone had a stroke of genius when they decided to weave a program from threads of traditional clinical discussions with a chance to talk about concerns and provide new information about the evolving policy issues that will determine the future of practice in Vermont.
Perhaps you heard about the proposal that Vermont’s Governor Shumlin had supported that would have created a single payer system. “Single payer” had been under strategic development for most of the past four years until the Governor withdrew the recommendation earlier this year. The Governor’s decision to abandon a single payer model did not change the perceived need for statewide clinical integration, quality improvement and cost reduction. It did not change the concern of many that the future health of Vermonters is at risk from the rising costs of the current system of fee for service care. Abandonment of a single payer model did not change the fact that there is a majority opinion within the state that the future health of Vermont’s citizens is absolutely dependent on clinical collaboration and cost control.
Vermont has been actively trying to find its way to a better system of care since the 90s. Since 2006 “The Blueprint for Health” has been Vermont’s state-led initiative to implement PCMH related initiatives in every practice in the state. Since 2010 Vermont law has defined the Blueprint as a “program for integrating a system of health care for patients, improving the health of the overall population, and improving control over health care costs by promoting health maintenance, prevention, and care coordination and management.”
“The Blueprint” has had some successes and some failures. As is true with all attempts to create meaningful change, the journey to the vision of all Vermonters getting care in a medical home environment has been slow. Meaningful change in social and professional systems is always slow and there are always barriers. The critics accentuate the barriers and the proponents inflate the successes. The “Blueprint” vision was laudable but incomplete because it did not adequately address issues of finance and the integration of the primary care medical home with the rest of the care delivery system. Now the Green Mountain Care Board has broad authority that may accelerate the journey toward the vision that the Blueprint is seeking to describe.
Creating a confluence of resources that are an alternative to single payer and supporting the evolution of a single ACO that will be the delivery mechanism that combines the improved primary care practices with the hospitals and specialists as one integrated system are the dual challenges that the Green Mountain Care Board has the authority to assign to itself. Vermont through its legislature and its own experience has created a moment of opportunity that is truly remarkable.
