by Rob Roper
Montpelier – The five members of the Green Mountain Health Board met officially for the first time at 1:00 pm at the BISHCA offices in Montpelier. The goal in assembling them, according to Governor Peter Shumlin, was to put “really smart people” in charge of the healthcare reform process to avoid yet another government failure on the issue. Indeed, Shumlin has acknolweded that, as far as health care is concerned, government has “gotten in wrong every single time.”
Today the five new members of the Board, Dr. Alan Ramsay, Dr. Karen Hein, Con Hogan, Al Gobeille, and chairwoman Anya Rader Wallack, got the official briefing on what they have to get right.
Cliff Peterson, Special Assistant Attorney General, preformed the honors with a dry sense of humor that underscored the absurd impossibility of the task ahead.
“As to your authority and your duties, there are lots of them and they are quite broad,” explained Peterson. “I’ll just hit some high points here. The general charge, modest as it is, goes as follows, You’re charged with improving the health of Vermonters, reducing the rate of growth in healthcare costs, enhancing the patient and healthcare professional experience, recruiting and retaining high quality health professionals, and achieving administrative simplification both in financing and in delivery of healthcare.” He added wryly, “That’ll be done by Friday.”
“More particularly,” he went on, “you have the authority to achieve payment reform and cost containment, and the Act does not establish any limits on that, other than the rule of reason. You can, for example, set rates for healthcare professionals, for manufacturers of drugs, for medical supply companies, and the like, and for other companies providing services. You will be approving payment methodologies to achieve quality and cost containment at the same time.”
The Board is also required under the statue to perform certain duties. “One which is to seek the advice of the healthcare ombudsman, who will represent the interests of patients and consumers, and may suggest policies to the board,” said Peterson. “You are also charged with establishing a consumer/patient/healthcare professional advisory group…. Your duties go as far as work force development in the health care world. Health information technology and the oversight of that and the plans for that. And, particularly, to review and approve the recommendations of the commissioner of BISHCA on health insurance rate increases, hospital budgets, and certificates of need.”
Those are just the immediate tasks for the Board. The future holds more power and more responsibilities.
“Looking a little farther down the line, it is the board’s job to review and approve the benefits packages to be offered in the Federally mandated health insurance exchange which starts in 2014,” said Peterson.
“For Green Mountain Care, when that comes, your authority and duties are largely similar: to define and approve the benefit package, including how to handle cost sharing, deductibles and co-pays, whether to make those income sensitive or not, and various other considerations that you may take account of, such as whether to include mental and vision, hearing benefits, long term care, and so on.”
Another small detail, the Board will also be determine a three-year budget for healthcare in Vermont.
And, that’s not all. Peterson went on to explain some of the rule making authority of the Board, like the need to create rules for appeals of their decisions. “For example, you deny a certificate of need. You’ll have to deal with how that’s handled in terms of appeals, because appeals from your orders will go straight to the Supreme Court… You will have to write rules subject to the Administrative Procedure Act for methodology achieving payment reform and containing costs, and the Green Mountain Care – that is to say the single payer benefit package – will also be defined by rule…. The rulemaking process is fairly complicated. Leaving aside how long it takes to draft the rule which will vary based on the nature of the rule, you should expect a six to eight month process from the first filing to the final adoption of the rule.”
“That,” concluded Peterson, “in short form, is what its all about.”
Chairwoman Anya Rader Wallack asked if there were any questions. There were none. “Anybody scared?” she asked. Some on the board shook their heads and smiled confidently. Others didn’t react at all.
Really smart people would be terrified.