By Alice Dubenetsky
As the Affordable Care Act (Obamacare), the potential implementation of Green Mountain Care (GMC), Vermont’s single payer health care overhaul, loom over the state, health care providers are positioning themselves to comply.
On Wednesday, October 24 a group of health care professionals met at the Sheraton Conference Center in South Burlington for a health care summit entitled “Achieving a Sustainable Health Care Future: Delivering Value to Vermonters.
A dozen speakers addressed the issue of improving health care delivery to Vermonters. Included among them were John Brumstead, CEO of Fletcher Allen Health Care; Mitch Fleischer, President and CEO of Fleischer Jacobs Group; Tom Huebner, President of Rutland Regional Medial Center; Church Hinds, President of the Vermont Visiting Nurse Association of Chittenden and Grand Isle Counties; Richard Slusky of the Department of Health Access, and Al Gobeille of the Green Mountain Care Board.
Perhaps anticipating the anxiety among the attendees about the upcoming changes, John Brumstead opened the meeting by informing the audience that this was not going to be a doom and gloom event, and that they would try to address what’s right with health care, and what is working. He introduced the new health care initiative OneCare Vermont, under which Fletcher Allen Health Care and Dartmouth-Hitchcock Medical Center of Lebanon, New Hampshire will cease to compete with one another and will both become part of an Accountable Care Organization called OneCare Vermont. Brumstead said that this Integrated Delivery System (IDS) will be a model for the future. The new initiative relies heavily upon technology and Electronic Health Records. Brumstead called it a patient-first system, and critical to reducing costs.
Fletcher Allen has already formed an alliance with Central Vermont Medical Center under a similar agreement called Fletcher Allen Partners. While the organizations remain freestanding hospitals, the goal is to improve patient care and reduce costs by working together to jointly purchase, borrow, develop quality and clinical initiatives and develop a common electronic health record system. The latter has been a stumbling block for health care providers for years, because there are multiple systems in use and none share a common language. Getting the systems to “talk to each other” is one of their more vexing challenges.
Brumstead allowed that the new initiatives will require change. “We welcome it. We have a tremendous opportunity to make a real difference to the entire population, creating the best health care system and creating a model for the country.”
Brumstead was followed by Al Gobeille, who, in addition to serving on the GMC board, is Chariman of the Burlington Business Association, and owner of Gobeille Hospitality and Lake Champlain Cruises. Gobeille is familiar with the anxiety the business community feels about the sweeping changes that are about to overtake the state and the country. He said that the changes are positive, and that there has been too much negativity in the press about GMC. Gobeille acknowledged the misgivings but, he argued, “discomfort is our ally. Act 48 provided the impetus for change, and we all share the discomfort.” He said that health care costs are currently not sustainable and we need to “unlock a cure for our system.” Discomfort, he said, motivates us to collaborate.
Churchill (Church) Hinds said that he, too, understands that ACO’s engender anxiety. He recalled the reaction to Medicare in the 60’s, which was a major shift in health care policy. “There must be a substantive change in the way Americans think about health care – patients, providers and insurers. It is more as a collective endeavor than an individual endeavor.”
The idea of a collective endeavor does not sit well with some private practitioners, however. During a question period, a doctor with a private practice wondered how, as a small business with an independent practice, could he fit into the changes, when the trend is for all practitioners to be employed by large hospitals and clinics? Are independents practitioners part of the collaboration or an obstacle?
Al Gobeille responded that their future is as bright as they make it, but other panelists, including Tom Huebner of Rutland Regional Medical Center, were less encouraging. He said that he can’t recruit independent practices “because of reimbursements” and that they are trying to “make something better”. Clearly, the panelists were as uncomfortable with the question as the questioner was about his future.
All of the panelists are sincere, dedicated health care professionals who are earnestly trying to work toward a more cost efficient health care delivery system. Whether that can happen in the context of state and federal bureaucracy and the regulations and burdens they will surely impose remains to be seen. For now, they are working hard to improve patient care in Vermont, and trying to keep a positive attitude in the face of uncertainty. Interestingly, the one issue that weighs most heavily upon many Vermonters was not addressed. How much will all of these changes cost, and can the taxpayers afford to shoulder the burden?