Sunday, September 20, 2009

Workable Health Reform is Key

“The nation stands ready to reform our healthcare system and the governors need to define their roles and work to develop a more coordinated and efficient system”, said Vermont Governor Jim Douglas speaking at the National Press Club on September 17th.

He continued to say “Health reform is imperative because healthcare is such a huge portion of the national economy in terms of its percentage of our gross domestic product. It is also becoming a large percentage of every state’s operating budget. States are going to have to make tough decisions in the coming years to balance the budgets and avoid increasing taxes to a level that will stop growth.”

For example, Medicaid alone is nearly 33 percent of a single state’s budget but in Vermont with its expanded program, the cost is even greater and is expected to only rise in the future. In addition, Vermont is the second oldest state in terms of median age so the elderly population health needs have to be addressed.

Coverage issues are very important but dealing with coverage alone isn’t enough. Coverage without significant improvements to the healthcare delivery system along with substantial efforts to lower health care costs will put the system under further strain according to the Governor.

The Governor reports that Vermont has gained a national reputation for implementing reforms with good results. For example, the “Blueprint for Health” in place for 6 years is a vision, a plan, and a statewide partnership to improve the healthcare system in the state. The program provides information and tools to enable the people with chronic conditions to manage their own health needs.

The program is establishing a new way to practice medicine to help care for the chronically ill. The governor pointed out that there are three communities across the state where a primary care delivery model such as a medical home looks very promising. The concept makes it possible for Vermonters to have a medical home affiliated with a practice, to include not just a physician but a nurse, a behavioral health specialist, a dietician, and whatever else is needed.

Communities all over the state are joining Blueprint to have the right information at the right time and the program has developed a web-based chronic care patient information system that is free to healthcare providers and requires only internet access.

HHS Secretary Sebelius, the Director of the White House Office of Health Reform Nancy-Ann DeParle, along with the Governor just announced a new initiative to enable Medicare to join Medicaid and private insurers in state-based efforts to improve the way healthcare is delivered.

This new initiative will mark the first time that Medicare will be a full partner in these experiments and will build on the medical home model now being tested in Vermont. Under the Vermont model, private insurers will work in cooperation with Medicaid to set uniform stands for medical homes.

States wishing to participate must certify that they have already established similar cooperative agreements between private payers and their Medicaid program, demonstrate a commitment from a majority of their primary care doctors to join, meet a stringent set of qualifications for the doctors who participate, and integrate public health services to emphasize wellness and prevention.

The Governor feels very strongly that state health IT initiatives underway need to be integrated with HIEs. States need to work with the exchanges and state Medicaid programs so that low income individuals can get the appropriate program placement and services and coordinate these services with other services such as food stamps and welfare assistance.

The Governor mentioned that to promote health technology, Vermont has a program called “docsite” where laptops are given to providers, along with information. The information on the program is available at to provide clinicians with tools that are easy to use and affordable. Whether a doctor practices as a sole provider in a multi-disciplinary setting or even manages a network of integrated physicians, the site helps to build and maintain software tools to help in the healthcare setting.