Tag Archives: Green Mountain Care Board

Are We Sure the Green Mountain Care Board Knows What the Hell It’s Doing?

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Shots fired!

In response to revenue cuts ordered by the Green Mountain Care Board, the University of Vermont Health Network is slashing services at multiple locations. Most egregious, to me, is the closure of Central Vermont Medical Center’s inpatient psychiatric unit.

Reminder that we’ve had a chronic shortage of inpatient psychiatric space more or less continuously since 2011, when Tropical Storm Irene put the final nail in the old Waterbury state hospital’s coffin. And now we’re cutting eight beds?

A cynical observer might infer that UVMHN disagrees with the Board’s mandate, and is forcing the issue with unpopular and/or unworkable reductions. Seven Days’ Derek Brouwer wrote that the Network’s announcement “ratchets up a long-simmering tension” between the Health Network and the Board.

The Board was in a ratcheting mood itself. It issued a huffy statement Thursday afternoon expressing deep concern with the cuts and asserting that it “was not consulted on, and did not approve, these reductions.”

Well, boo frickin’ hoo.

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The Incredible Lightness of Phil Scott

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A couple days after our uneventful primary, I roused myself from my Covid-induced stupor long enough to make a guest appearance on The Montpelier Happy Hour*, a weekly podcast co-hosted by journalist/broadcaster Olga Peters and Rep. Emilie Kornheiser, who was fresh off her pasting of a centrist primary challenger. Kornheiser said something that stuck with me. (Which is not unusual.)

* Video here, podcast here.

While campaigning, she asked constituents about their views of Gov. Phil Scott. She was looking for insight into the central mystery of today’s Vermont politics: Why do so many people happily vote for the Republican governor and otherwise elect Democrats up and down the ticket?

The most common response she got: Scott’s calm, reassuring leadership during the Covid epidemic. They still appreciate his even-handed approach, especially in comparison to the nutbag in the White House who talked of injecting bleach and sticking lightbulbs up your fundament. People presumably believe Scott would do the same thing in the next crisis, and that’s comforting.

But here’s the problem. When the times call for a steady hand on the tiller, Scott is that steady hand. When the times call for decisive leadership, Scott is that steady hand.

Vermont faces an array of challenges and crises. He’s been Vermont’s chief executive for seven and a half years now. I dare you to name a single major issue that’s improved substantially since Scott became governor. Instead, we have a perpetual standoff with the Legislature, which is trying to pry the tiller away from his steady hand. He offers much more resistance than direction.

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Oh Look, It’s the Health Care System Murder Board

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There was plenty of talk during the 2024 legislative session about housing, homelessness, Act 250, climate change, school funding, crime, opioids, and other big issues. I don’t recall health care occupying the spotlight at all.

And then last week, an outside consultant delivered a devastating assessment of our “badly broken” health care system and said that wide-ranging “structural reform” is needed as quickly as possible. Or, for those underwhelmed with what passes for leadership in our Brave Little StateTM, much quicker than seems plausible.

Maybe the only person who might feel a little bit good about the consultant’s report (downloadable here under the title “State-Level Recommendations for Hospital Transformation,” because the Green Mountain Care Board is all about that clickbait) is former governor Howard Dean. You may recall that when he dipped his toe, ever so briefly, into the political waters, health care was the only issue he spotlighted. I noted that it was kind of refreshing to hear someone focus on health care, which seemingly left the front burner after former governor Peter Shumlin abandoned single-payer health care.

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GMCB Adds a Dab of Lipstick, Hopes You Won’t Notice It’s Still a Pig

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Well, that didn’t take long. In fact, it couldn’t have happened any faster.

Two weeks after public comment forced the Green Mountain Care Board to defer cancellation of a plan that might have led to a badly-needed increase in inpatient mental health beds, the Board came right back and went ahead with the deal today with minimal amendment. It stands essentially as it did before: it lets the University of Vermont Health Network off the hook for designing a new inpatient facility, thus closing the door on the best opportunity to resolve our 12-years-old-and-counting* crisis on inpatient mental health care.

*That’s the generous count, starting the clock with Tropical Storm Irene. If you want to include the dilapidated, outdated old state hospital, well, the crisis goes back a lot further.

The revised plan requires UVMHN to invest $18 million in boosting “capacity of mental health services in the state.” Not “inpatient,” mind you, but “mental health services” of any sort. The Board then punted review of UVMHN’s plan to the Department of Mental Health because, as Board member Jessica Holmes put it, “we’re not the experts” and DMH is.

It also allows the GMCB to wash its hands of the whole mess, but that’s just a bonus.

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We’re Not Retreating. We’re Advancing to the Rear.

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What is an institution to do when it makes a decision that kinda blows up in their face? Well, one option is to stick with the decision but modify it just enough to quiet the critics. Or to put it metaphorically, apply enough lipstick to a pig and make people stop noticing it’s a pig.

As it happens, two august Vermont organizations are currently engaged in the messy business of searching for the minimum acceptable capitulation. Vermont State University is trying to figure out how many books it will have to preserve, not because it wants the damn things, but because it desperately needs to quiet the howls of criticism; and the Green Mountain Care Board is looking for a way to give away $18 million while convincing us that they’re not giving away $18 million.

VSU’s nascent leadership continues to fumble its plan to close the campus library system… sorry, create something better than libraries… no wait, they’ll still be libraries but unencumbered by books… oops, now we’ve got a “refined plan” that will select the most academically important volumes while disposing of the rest. (You can tell they’re proud of their plan because they posted it online last Thursday with no formal announcement or public event of any sort.)

Gee, it’s almost as if the original plan was thrown together in haste with minimal forethought. Which inspires no confidence in the ability of this administration to lead a troubled system out of its current straits and into a better tomorrow. The future of VSU’s library system is way down on the list of critical issues to be addressed. If they can’t handle this without it blowing up in their faces, how will they address a massive structural deficit when they’ve already squandered their credibility dicking around with the library plan?

And all the while, they insist they’ll implement this vaguely defined thing by the end of June, come Hell or high water.

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Green Mountain Care Board Prepares to Punt Away an Investment in Inpatient Mental Health Care

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Our health care guardians at the Green Mountain Care Board are trying to sneak through a bit of business that combines bad policy with questionable procedure.

Well, I guess that explains the “sneak through” part. They can’t be proud of this.

Six years ago, the GMCB ordered the University of Vermont Medical Center to take $21 million in surplus revenue and spend it on developing a plan to boost inpatient mental health care, which has been abysmally lacking since Tropical Storm Irene wiped out the old state hospital in 2011. We’re now in our twelfth year of inadequate inpatient care that has left severely mentally ill patients languishing in emergency rooms and frontline providers dealing with the consequences.

The failure to address this situation ought to be a source of embarrassment if not shame to Our Political Leaders.

Anyway, it seemed like a decent idea: Let UVMMC use the surplus to tackle a challenge that nobody else would.

Well, now the GMCB is about to let UVMMC off the hook, further delaying any meaningful response to the shortage of inpatient care. And the Board trying to rush it through with the least possible fanfare.

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What Is This “Health Care System” Of Which You Speak?

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If there was an organizational chart outlining America’s process for supplying and paying for health care, it would look something like this. It’s not a “system” as much as a mare’s nest that grows more and more complicated — and less efficient and increasingly unjust — over time.

I’m guessing here, not a health care management expert or anything, but this mess has got to be costing us untold billions that might otherwise go to, I don’t know, making people healthier? There are inefficiencies, redundancies, and a massive amount of profit-skimming at every turn. That’s why other developed countries can provide much broader and more equitable coverage at a much lower cost. I have often thought that health care in America would be cheaper if we simply left big bags of cash everywhere.

Aside from the inadequacies and inequities of our “system,” there’s also the fact that it’s completely out of our control. Decisions made at high corporate levels trickle down like warm piss upon our heads, and damn but we’d better be grateful for the golden showers.

This line of thought was triggered by VTDigger’s story about likely reform efforts in the state Legislature. A story that could have been published, with alterations in the details, just about any time in the past. Yep, our health care “system” needs reform, and by God, our elected officials are gettin’ to work.

But the scope of that work will be limited indeed.

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The Dangerous Drift of Vermont’s Health Care System

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When he was governor, Peter Shumlin made a big push on health care reform. It didn’t end well for reform or for Shumlin. Since then, the system has become less functional and more expensive but there’s been no appetite for another push.

With one major exception, and that’s OneCare Vermont. It has soldiered on in its effort to rein in health care costs by paying providers for outcomes rather than treatment. It has spent a tremendous amount of money, but so far there’s not much evidence of impact.

That’s troubling, and it’s more so when you read VTDigger’s piece about the latest Green Mountain Care Board meeting. Beyond that, there’s a broader critique of our health care system in a recent series of essays by journalist and health care policy analyst Hamilton Davis. Taken together, it looks like a huge sector of our economy (upon which our physical and financial well-being depends) is drifting along with a bunch of people who call themselves “Captain” staying as far away from the helm as they can.

The Digger article makes the leaders of OneCare look like The Gang That Couldn’t Shoot Straight. The GMCB, especially its new members, were asking questions that shouldn’t have been tough to answer. For instance, do you have any evidence that your system is working? Can you point to measurable results in terms of cost savings or improved outcomes?

OneCare leaders seemed to be taken aback by this line of questioning.

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Court Locks Black Box

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Do high courts do Friday newsdumps? It would seem so. The Vermont Supreme Court issued a ruling on Friday, July 1 — heading into a three-day holiday weekend — with massive implications for independent oversight of OneCare Vermont, our favorite too-big-to-fail institution, and for the state auditor’s office.

The newsdump worked like a charm. VTDigger cranked out a quickie same-day story that hit the Internet at a time when lots of people had stopped paying attention to the news. By Tuesday, July 5, the decision had pretty much vanished from public attention. A strong statement from Auditor Doug Hoffer blasting the decision went largely unnoticed. But I sure hope responsible parties in the Legislature have taken note, because something needs to be done to fix this.

The unanimous decision denied Hoffer access to OneCare’s payroll information. He had sought access after OneCare’s payroll and benefits expenses jumped from $8.7 million in fiscal year 2019 to $11.8 million the following year. He understandably wanted to find out why. It’s an issue that should concern us all because OneCare is (a) kind of a rolling experiment that’s (b) playing with massive amounts of public money for which it is (c) not very accountable at all.

I’ll get back to OneCare, our most mysterious of public sector black boxes, but first I want to discuss the Auditor’s part of this. The court ruled that the Auditor has no authority in statute or in contract to access OneCare’s financial records. It asserted that financial oversight belongs solely to the Green Mountain Care Board, which is essentially OneCare’s captive partner in this grand experiment.

Well then, I ask, what in hell do we have an auditor for?

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The Curious Case of the Single Intolerable Word

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Gather ’round, children, and you shall hear… how Vermont’s biggest health insurer has gotten its knickers in a twist about one single word in a Green Mountain Care Board decision. The word was so objectionable that Blue Cross Blue Shield of Vermont appealed the decision solely because of that word. It did not object to any other part of the ruling.

When the appeal was denied BCBSVT took the case to the Vermont Supreme Court, where it awaits action. Seems like a whole lot of time, trouble and billable hours for a single word, but what do I know.

Let’s go back to the beginning. On May 7, Blue Cross Blue Shield of Vermont filed a request for 2022 insurance rates with the Green Mountain Care Board. The Blues asked for a 7.9% increase on individual policies, and smaller increases for group plans.

The request meandered through a lengthy series of briefs, filings, hearings and testimony. (All can be downloaded from this webpage.) On August 5, the GMCB issued its decision, knocking down the rate hike on individual policies to 4.7%. In its decision, the GMCB characterized the 7.9% request as “excessive.”

There. That’s the fatally toxic word. ‘Excessive.”

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