Rhode Island or Vermont -- Who has the Right Answer for Healthcare Reform?

I had the opportunity to interact with two individuals who have significant roles in leading healthcare reform in Rhode Island (RI) and Vermont (VT)—Christine (Christie) Ferguson and Anya Rader Wallack.

Christie Ferguson

Christie Ferguson has been appointed Director of the RI Health Benefits Exchange. She’s been on the job for five weeks and is struggling with the balance of just getting the Exchange functioning and addressing the larger issues of improving outcomes and controlling costs. She clearly understands that insurance coverage is important, but not sufficient. Improving the effectiveness and efficiency of the system had to be accomplished through the aggregated purchasing power of the Exchange. The purchasing power amassed through the small employer groups and the non-group individuals mandate —those likely to obtain coverage through the Exchange—will not be sufficient to drive the necessary changes. She faces the challenge of somehow marshalling the purchasing power of state employees (19,000) and Medicaid (224,000) to implement payment reform and other tactics designed to improve quality and bend the cost curve.  Other populations that might be coordinated are municipal employees. Coverage is currently purchased for these employees through several buying cooperatives. The question is whether the regulatory and political climate will make it possible to have all of these entities establish similar standards for their plans related to the role of primary care, participation in the provider network, generic drug use and quality. This is a tall order, but Ms. Ferguson has experience in state government and may be able to pull it off.

Anya Rader Wallack

Anya Rader Wallack hasn’t been around healthcare as long as Christie Ferguson, but she finds herself heading up a very ambitious effort in VT to change the state’s healthcare system. Until her recent appointment as Chairwoman of the Green Mountain Care Board, Ms. Rader Wallack served as the Deputy Chief of Staff to Governor Shumlin for Healthcare Reform. The Green Mountain Health Board was created by the VT Legislature in 2011 to:

·         improve the health of Vermonters;

·         oversee a new health system designed to improve quality while reducing the rate of growth in costs;

·         regulate hospital budgets and major capital expenditures as well as health insurance rates;

·         approve plans for health insurance benefits in Vermont’s new “exchange” program as well as plan to recruit and retain health professions; and

·         build and maintain electronic health information systems.

Wow! That’s an impressive set of goals and a tremendous concentration of power in the hands of a five-person board consisting of two doctors, a business owner and the VT Secretary of Human Services, in addition to Radar Wallack. VT has a population of 619,000, one major teaching hospital (Fletcher Allen in Burlington) and 13 community hospitals. Many Vermonters are served by the Dartmouth-Hitchcock Medical Center, another major teaching hospital located just over the border in Hanover, New Hampshire. Radar Wallack says that, although a Healthcare Exchange will be implemented, it will not be the centerpiece of reform in VT. She and her staff are spending more time reviewing hospital budgets and launching projects to test new payment methodologies.

Keep in mind that neither state has the ability to directly affect changes in the Medicare program (18% or 111,420 in VT and 17% or 176,375 in RI) or employer self insured programs, which are regulated under federal laws.

Which state do you think has the greatest chance of successfully extending coverage, improving quality and bending the cost curve?

I look forward to your comments and opinions. —Lou Giancola