Based on the outcome of the upcoming 2016 elections, the fate of the nation’s healthcare system may face yet another potential shift in key provisions and priorities. As we head toward November, public and private agencies committed to improving healthcare accessibility, affordability, and transparency are working hard to plan ahead for possible shifts in the federal government’s agenda and funding. One such example: Vermont’s Green Mountain Care Board (GMCB).
Shortly after the passage of the Affordable Care Act of 2010, the Vermont legislature created the GMCB in 2011 to reduce the cost of healthcare and improve the health of Vermonters, seeking results otherwise unattainable in the midst of shifting national reform efforts. The GMCB, which is governed by an independent board of five Vermonters, is charged with three main responsibilities: regulation, innovation, and evaluation.
As Susan Barrett, JD, Executive Director of the GMCB, notes, the GMCB “has ‘teeth’ in the state of Vermont’s regulative, innovative, and evaluative functions – and we do it all under the same roof. That charge spans involvement in insurance rate review processes, payment reform pilots, hospital budget review and approval, and the Vermont Health Care Innovation Project. For an independent, five-member board, that role description isn’t all that common nowadays!”
The common thread that enables the GMCB to deliver on its legislative intent: the state’s all-payer claims database (APCD), the Vermont Health Care Uniform Reporting and Evaluation System (VHCURES), which has been operated by Onpoint since the database’s launch in 2008.
“I liken our claims data to the blood that runs through the veins of the board,” says Barrett. “It’s everywhere and needed for the state’s progressive steps toward healthcare transformation.”
Barrett, an attorney, brings to the GMCB a breadth of experience in the healthcare industry from both a business and policy perspective, with nearly 20 years in the pharmaceutical industry with Novartis, Merck, and Wyeth and having previously served as the Vermont Director of Public Policy for the Bi-State Primary Care Association, a nonprofit organization that promotes access to effective and affordable primary care and preventive services in New Hampshire and Vermont. In her role as the GMCB’s executive director, Barrett manages the board’s operations, administration, and finances; supports the group’s policymaking work; and serves as the liaison for stakeholders and other state sectors.
Barrett describes the need – and benefit – of having data at the board’s fingertips: “We routinely have to dig into the VHCURES data to research myriad issues around Vermont’s healthcare landscape. VHCURES is a powerful data tool that allows the board to analyze health data and is essential to informing our policy decisions.”
VHCURES, which covers approximately 90% of commercially insured residents and 100% of Medicare and Medicaid beneficiaries in Vermont, has become a key means for the board to better monitor and forecast the cost, utilization, and quality of the state’s healthcare services. Pivotal to the ongoing work of Vermont’s Blueprint for Health initiative, a nationally recognized program of advanced primary care medical homes, VHCURES also serves as a crucial source for a number of the GMCB’s analytic activities, including its annual healthcare utilization and expenditure analysis, ongoing evaluations of payment reform and innovation models, assessments of Accountable Care Organization performance against cost and quality measures, modeling of progressive payment reforms, and multiple special studies.
As the GMCB looks ahead to 2016, Barrett notes that two of the board’s top priorities will be to continue to integrate the complementary functions of regulation, innovation, and evaluation and to maximize the transparent process for policy- and decision-making (e.g., continuing to monitor, share, and discuss the impacts of policy change and reform on Vermont’s healthcare workforce).
As the GMCB continues to make quality healthcare even more affordable and accessible to Vermonters across a variety of settings, the coming year will surely be an exciting time for the GMCB and its ever-expanding use cases of VHCURES.
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- Understanding Your Enhanced Summary Tables: Inpatient Stay Summary & Medical Claim Header
- Washington Looks to Its APCD to Support Balance Billing Protection Act
- Onpoint Begins Work on Next-Generation APCD with the State of Vermont, Green Mountain Care Board