Vermont Green Mountain Care Board

At a state level, Vermont has been a leader in the country for its health outcomes (often ranked as #1 or 2 for all of the 50 states).  In 2011, then Governor Peter Shumlin committed his administration to creating a system of care based upon “value not volume.” This transformation was viewed as the way to both improve health outcomes as well as reducing cost.  A bold new law, Act 48 was passed by The Vermont Legislature establishing The Green Mountain Care Board to regulate, innovate and evaluate the outcomes of the comprehensive, visionary law.  The Board had unprescedented  powers over hospital budgets, capital expenditures, insurance rates and other parts of the health and medical system.  One major step to accomplish the goals to both save money and improve health was the establishment of a state-wide ACO (Accountable Care Organization) to include most hospitals and providers under an umbrella organization that was paid by different mechanism from the fee-for-service payment system that predominates in America. This ‘value-based payment system’  required the pooling of funds from the various major contributors, namely Medicare, Medicaid and commercial insurance companies.  By combining these separate pots of revenue into a common one, a more rational, cost-effective system of care could hopefully balance the expenditures towards early intervention and care, have a more appropriate distribution of scarce resources, including the health workforce needed to improve health and lower cost working in sync with public health efforts to prevent and improve the circumstances that often lead to poor health and disease.  These lofty goals are being pursued with many tweaks to the approach as the decade since the passage of Act 48 went into effect in the fall of 2011.  As one of the first 5 members of the Green Mountain Care Board, I was part of this bold experiment to shift to value-based payments.  Time will tell if Vermont will succeed, but the State has certainly been a leader in trying to tackle all of the moving parts of our healthcare system.  Even during the recent COVID pandemic, Vermont has been a leader in the nation for low rates of dealth, and highest rates of vaccination (currently at 90% at the end of 2021).