Opportunity here to start new dialogue on health care

Tuesday the leadership of the University of Vermont Health Network sent to the Green Mountain Care Board [GMCB] a letter that can only be described as the mea culpa - “through my fault” - of all mea culpas. Ultimately, if agreed to, it may also change the face of health care in Vermont.

The first paragraph of the letter - which is on Page 8 - reads: “Last fall, the University of Vermont Health Network made difficult decisions that created fear and frustration, and we disappointed our patients and the communities we serve in Vermont. We understand the impact of those decisions and are working hard to earn back public trust. As we move forward, we are focused on rebuilding and strengthening our relationships - with our communities, with the Green Mountain Care Board, and with our employees - through open dialogue, accountability, and a renewed commitment to excellence in care and service.”

That’s a lot of apologizing for the largest employer in Vermont and the 800-pound gorilla of the state’s healthcare system. 

The simmering conflict was centered, in part, on the GMCB’s refusal to approve UVM’s budgets in recent years, prompting UVMMC to file suit against the state’s regulator. The struggle, reduced to its essence, pitted the regulator against the regulated. The regulator - GMCB - has the responsibility to oversee the state’s health care system, ensuring it operates in a sustainable and affordable fashion. The regulated - UVMMC - is responsible for providing the necessary care in a timely fashion and in a way that keeps the doors open.

It’s a challenging task, no matter which side of the divide. But for UVMMC it was becoming apparent that a continued stalemate held little promise for meeting the demands of a changing environment, one that includes what happens in Washington as well as in its own backyard. Nor was the GMCB about to retract its prior decisions.

The agreed-to memorandum includes UVMMC paying $11 million to primary care providers not employed by hospitals, $12 million to Blue Cross Blue Shield, and an agreement to tie executive bonuses to performance standards. It also addressed the need to bring in payments from New York hospitals and to cut prices charged to commercial health insurers.

In exchange, the GMCB will allow the hospital to take in more revenue from patients for the next two years and will drop its actions against the hospital for past budget concerns.

It’s an agreed-to effort to wipe the slate clean and begin anew, which from both sides is probably welcome. To that end UVM submitted to GMCB budgets for the next several years that follow GMCB’s “guidance.”

But tucked into the proposal is also the agreement by UVMMC to spend roughly $15 million over the next sixteen months to hire specialized consultants and a Vermont-based “liaison” to comb through UVMMC’s operation looking for cost efficiencies and potential change in medical practices. There will be a five-member “workgroup” to oversee the consultants’ work, two from UVMMC, two from the GMCB, and an independent liaison. 

That is a mammoth and unprecedented undertaking. And, on a five-member board the fifth member - the independent liaison - will often hold the deciding vote. That’s a lot of power. Choose wisely.

The nine-page memorandum of agreement is complicated. Understanding how it affects health care and our pocketbooks is beyond anyone’s quick glance.

Which gets us to the part that concerns us. Included in the agreement is this: “The independent Liaison and other professionals will have no media communications unless specially authorized by the workgroup.” 

Two points: First, the groups involved have enormous power. Perhaps more so than any other group in Vermont considering the fact that health care makes up 20 percent of the state’s GDP. There needs to be a public accounting of the process. Second, It’s precisely because it’s complicated and so far-reaching that the public needs to have the process reported as the news happens, not at the end of the 16 months, when it’s too much to digest. That’s also the better way to reestablish the public’s trust.

Is that a little messier? Maybe. But for the $15 million set aside for experts to possibly suggest how a two billion dollar healthcare system can be improved, and how Vermont can retool its healthcare system to be more affordable and best suited to each geographical location, it seems a journey we all should be on each step of the way.

Being adequately informed is what builds the trust upon which all can be accomplished. There is no issue in Vermont that is more pressing than the strength of our health care system.

It’s time for the collaboration to begin.

By Emerson Lynn