From left to right: Owen Foster, David Murman and Robin Lunge have been appointed to the Green Mountain Care Board by Gov. Phil Scott on Sept. 8, 2022. Courtesy photosThe Green Mountain Care Board will sign on to an agreement that moves Vermont towards a new federal model for health care reform, following a vote Friday that split the members of the five-person regulatory body. The complex agreement, which would put participating hospitals under a global budget and provide regular payments to primary care providers, would begin in January 2027 and last for nine years. Eventually, its details would govern much of the more than $3 billion in health care payments that the federally-controlled Medicare and Medicaid programs make every year to Vermont care providers.  Gov. Phil Scott signed the agreement on Thursday, Health Care Reform Director Brendan Krause told the board prior to the vote.  It also requires sign-off from Jenney Samuelson, secretary of the Agency of Human Services, who backs the arrangement. Green Mountain Care Board members voted 3-1 with one abstention to approve joining the new alternative payment structure for health care providers offered by the U.S. Centers for Medicare and Medicaid Services.  Known as the AHEAD model, it would replace the Vermont-specific “all-payer” model that expires at the end of this year. However, that approval comes with several significant conditions, including that the board receive a state appropriation that would allow it to hire five more staff members by September and a total of 20 by mid-2026.Board chair Owen Foster and members Robin Lunge and David Murman voted to enter into the agreement. Thom Walsh voted against it, and member Jessica Holmes abstained from voting, explaining she did not have enough information on the potential risks of the model to make a decision.Both Foster and Murman said the decision was the hardest they have made during their tenure on the board. “Designing and implementing a wholesale new payment delivery reform doesn’t just happen. It takes scores of people,” Foster said, explaining the board’s need for more staff. “If the model is not adequately regulated and sufficiently resourced, it will fail dramatically and harm patients and harm our health system.”Any one of the six listed conditions not being met would allow Foster — in consultation with Murman and board staff — to unilaterally withdraw the state from the agreement, according to the motion. The second condition is that the federal agency accept the methodology for setting global budgets developed by the board. Leaving the agreement requires 30-day notification only before the launch, after which a state must provide six months notice before withdrawing. Another condition is that the board maintain its independence and its role regulating hospital budgets and payment reform. Last year, Sen. Ginny Lyons, D-Southeast Chittenden, sponsored a bill that would have put many of the board’s responsibilities under the auspices of the Agency of Human Services. That did not advance, but in public comments critics of the new federal model said the agreement could potentially give the agency undue influence over the approval of hospital budgets.Yet another condition is that no hospital participates in the payment structure that is directly or indirectly supporting a non-Vermont based hospital, or is owed money or has forgiven a debt owed to it by an out-of-state hospital. “We want to ensure that our health care dollars are staying in Vermont now and in the future,” Foster said, when Lunge asked about the purpose of those conditions.READ MORE As UVM Health Network cuts services in Vermont, it expands in New York  by Peter D'Auria December 22, 2024, 6:54 amDecember 20, 2024, 8:33 pm The types of health care offered at three New York hospitals under the umbrella of the University of Vermont Health Network are expanding at the same time that the network announced cuts at two of its Vermont hospitals: University of Vermont Medical Center in Burlington and Central Vermont Medical Center in Berlin. Meanwhile, federal filings show that two out of the three New York hospitals lost roughly $90 million in fiscal years 2022 and 2023. One of them appears to have been operating with negative cash on hand in 2023 and 2024, according to a health network submission to the board.All five of the board members described concerns about the complexity of the model — that it might be more costly to operate than the savings it provides. The work required will be difficult and ongoing, said Murman, adding, “This is not going to be a super-smooth process. This is going to be an iterative process.”Other concerns Murman aired were that setting  hospital global budgets will incentivize hospitals to reduce patients’ access to care, when that is already a critical problem in Vermont. That is what studies have shown has happened in Maryland, which is the only state that has implemented global hospital budgets statewide, he said.The agreement states that Vermont will enter the second cohort in the program, meaning that the new model will not begin until 2027. Maryland may be the only state that participates in the first cohort, which begins in January 2026. The decision to delay entry into the AHEAD model leaves primary care providers concerned that the “all payer” model will end without anything to take its place. They receive roughly $20 million through different programs run by OneCare Vermont allowed by the current federal agreement.“Those are dollars that fund real people that are providing service to Vermonters,” said Mary Kate Mohlman, policy director for the Bi-State Primary Care Association.Read the story on VTDigger here: Vermont moves ahead with new federal health care payment model.