Vermont: Implementation of Comprehensive Reforms
In 2005, Vermont was faced with a situation where about 60,000 Vermonters (about 9.8 percent) lacked health insurance. Three-quarters of these reported cost as the central reason for their uninsured status. About half of the uninsured were eligible for existing public programs but were not enrolled.[i] In response, the Vermont legislature and Governor Jim Douglas reached agreement on a series of health care reform bills aimed at achieving near-universal coverage by 2010.
Since the first health care reform bills were signed into law in 2006, Vermont has been working to implement a comprehensive set of legislation to make health care affordable, accessible, and of high quality for all Vermont residents. Through Green Mountain Care, the state and its partners have made available a family of low-cost and free health coverage programs. One of these programs, the Catamount Health Plan, offers a non-group insurance product for uninsured Vermont residents and began enrollment of eligible Vermonters in 2007. Catamount Health continues to be the centerpiece of the reforms. Vermont also has several programs to address the affordability of health insurance through premium assistance programs. The state provides premium assistance for Catamount Health on a sliding scale basis to enrollees with incomes under 300 percent FPL and also provides premium assistance to individuals and families in this same income category to enable enrollment through their employer-sponsored insurance plan.[ii]
Vermont set aside $1 million for the Green Mountain Care outreach campaign, which began in late 2007. The state contracted with a media firm to create a campaign designed to get the word out about the range of Vermont health programs, especially the new premium assistance programs. The media launch increased visits to their Web site by about four times and calls to their toll-free number by about 40 percent. By the end of February 2008, 3,344 individuals were enrolled in Vermont premium assistance programs out of the estimated 10,341 who are eligible. Vermont’s most recent survey in fall 2008 found its uninsured rate is now about 7.6 percent.[iii]
Vermont’s health care reform is financed by:
- Individuals who pay sliding scale premiums based on their income;
- A contribution from employers based on the number of employees;
- Revenue from an increase in tobacco taxes;
- Medicaid savings due to employer-sponsored insurance enrollment; and
- Matching federal dollars under a federal Medicaid demonstration waiver.[iv]
Vermont’s health reform efforts related to wellness, prevention, and chronic care management rely on the premise that improving the quality of care and preventing disease are effective ways to reduce overall health care costs in the long run. The Vermont Blueprint for Health is a plan involving a statewide partnership to provide information, tools, and support to Vermonters who suffer from chronic conditions and to the providers who care for them.[v] Some of the key components of the Blueprint integrated pilot design include:
- Multidisciplinary Community Care Teams (CCT)
- Staffing mix designed by the community to supplement existing resources
- CCT in each community includes prevention specialists
- Integration of public health prevention and care delivery
- Financial Reform
- A common form of enhanced provider payment across the three major commercial insurers in Vermont and Medicaid (Medicare is not participating)
- Shared costs across all payers (except Medicare) for CCTs
- Health Information Technology
- Web-based clinical tracking system called DocSite
- DocSite supports age and gender appropriate health maintenance and care for chronic diseases
- Evaluation
- Multi-payer claims database
- Clinical process measures
- Health status measures[vi]
Several communities throughout the state have begun piloting the Blueprint and states and communities around the country are watching this model to see if it reduces costs and improves chronic condition management in the state.[vii]
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[i] “State Strategies,” State of the States, State Coverage Initiatives, AcademyHealth, January 2008.
[ii] “Overview of Vermont’s Health Care Reform,” State of Vermont Agency of Administration, September 2008; “Vermont’s Health Care Reform,” Vermont Agency of Administration. http://hcr.vermont.gov/.
[iii] “Update on Implementation of Coverage Expansions,” St@teside, State Coverage Initaitives, April 2008, available at www.statecoverage.org
[iv] “Overview of Vermont’s Health Care Reform” op. cit.
[v] Ibid.
[vi] “September Highlights,” State Quality Improvement Institute, AcademyHealth and The Commonwealth Fund. www.academyhealth.org/state-qi-institute/SeptemberEmailUpdatesCompilation.pdf.
[vii] “Vermont’s Health Care Reform,” Vermont Agency of Administration. http://hcr.vermont.gov/.
