Page 23 The Patient Centered Medical Homes Impacton Cost and Quality

MULTI-PAYER INITIATIVES: THE ROLE OF PAYMENT REFORM
VERMONT BLUEPRINT FOR HEALTH
Author: Lisa Dulsky Watkins, MD, Former Associate Director, Vermont Blueprint for Health
The importance of employers and payers investing in the PCMH model is critical because the extent to which
various payers – Medicare, Medicaid, commercial plans, and employers – are aligned around these payment
models is the extent to which true transformation of the US health care system is possible. These “multi-payer”
initiatives convince health care providers that the daunting task of redesigning their clinical practice is worth
the time, effort, and investment because a majority of their payer-mix supports the re-design. 77

The Vermont Blueprint for Health is a striking example of the effectiveness of a successful multi-payer reform
78
effort. The statewide adoptions of the spectrum of this multifaceted program can be linked to a long-standing
79
willingness to cultivate collaborative relationships among the various stakeholders. This demonstrable public-
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theoretical to the implemented.
Over the last decade, Bipartisan support in the public sector had a profound impact on the credibility of Health
Reform. Republican Governor Jim Douglas and an increasingly Democratic State Legislature found common
ground on key aspects of reform, joined by a commitment to grapple with predictions of escalating costs and
increasing morbidity in the aging Vermont population. Initial Blueprint activity was seated at the Vermont
Department of (Public) Health, seen widely as a neutral convener of the disparate groups brought together.

Meaningful engagement of the private sector was essential. From the very beginning, commercial insurers,
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to participate in the myriad planning and advisory committees. Attention was paid to the need for national
recognition of practices as PCMHs, the scale of enhanced payments to the practices, the initial development
and payment of the locally based care coordination teams, respect for the internal business processes of the
participating insurers and accountability of the Blueprint to its funders regarding outcomes.

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implementation and evaluation strategies to be undertaken. Their commitment to voluntarily support the
Blueprint was evident. There are self-insured employers already participating in the Blueprint despite their
ERISA exemptions, and discussion with others as well as with private payers as the impact on cost and quality
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insurers, but there remains the impact of the process undertaken in good faith.
80
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making the program “all-payer” through the lens of the practices and payers. 5HFRJQL]LQJ WKDW WKH DEVHQFH

of CMS as a payer was a critical problem in statewide implementation, Vermont leaders were instrumental in
the call for its involvement. The CMS Multi-payer Advanced Primary Care Demonstration, for which Vermont
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CONCLUSION

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