Health Care

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State to pay Blue Cross $3.5 million to settle billing discrepancies

MONTPELIER — State officials have agreed to pay Blue Cross Blue Shield of Vermont $3.5 million to close out the insurer’s line of business through the state’s online insurance marketplace in 2015. The additional payment to Blue Cross comes after a months-long reconciliation process that was required to help settle discrepancies within the billing and enrollment system of Vermont Health Connect, the state’s online health insurance exchange set up through the federal Affordable Care Act. The agreement between the state and Blue Cross was finalized late last year by the administration of former Democratic Gov. Peter Shumlin, who left office last week as Republican Gov. Phil Scott was sworn in. Cory Gustafson, Scott’s Department of Vermont Health Access commissioner, confirmed the $3.5 million settlement Thursday. Gustafson worked as the director of government and public relations for Blue Cross at the time of the settlement before being tapped to served in Scott’s administration. Continue Reading →

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Scott not sold on exchange report, will outline plan in budget address

MONTPELIER — Gov.-elect Phil Scott says a recent report recommending that the state stick with Vermont Health Connect has not necessarily changed his belief that the state should abandon the exchange as he prepares to outline his path forward later this month. Scott, a Republican who will be sworn in as Democratic Gov. Peter Shumlin’s successor on Thursday, promised during his campaign against Democratic gubernatorial candidate Sue Minter that he would seek to join the federal exchange or partner with other states, while shuddering Vermont Health Connect. The Strategic Solutions Group, an independent party hired by the Legislature to determine whether the state should stick with or abandon the exchange, released its report just before Christmas. The report noted the state’s exchange has “significant deficiencies” and more work is needed if it is to be sustainable. But it also asserted that sticking with Vermont Health Connect is preferable to the solutions Scott proposed during the campaign. Continue Reading →

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Scott announces two cabinet posts, staff positions

MONTPELIER — Gov.-elect Phil Scott announced two major appointments to his cabinet Tuesday, naming current Deputy Attorney General Susanne Young as his secretary of the Agency of Administration and Green Mountain Care Board Chairman Al Gobeille as secretary of the Agency of Human Services. Scott, a Republican who defeated Democrat Sue Minter last month to become the state’s 82nd governor, announced the two cabinet-level appointments along with a trio of staff who will work in the governor’s office when Scott is sworn in early next month in a news release Tuesday afternoon. “Susanne and Al are both accomplished and highly respected leaders who share my focus on making Vermont’s economy stronger and our state more affordable for businesses and families,” Scott said in a statement. “Together, they will be a strong and dynamic team, working together to modernize state government, put our state budget on a more sustainable path and move our healthcare priorities forward.”

Young, 60, will become, will become one of the most influential people in state government. The Agency of Administration oversees most aspects of state government, including development of the state budget. Continue Reading →

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Shumlin: Obamacare critical for Vermonters

MONTPELIER — Gov. Peter Shumlin is defending Obamacare and the state’s health care exchange as President-elect Donald Trump signals his intention to decimate them, a move the governor says will be an “extraordinary disaster for Vermonters.”

Shumlin, who is nearing the final month of his governorship, used a Montpelier news conference Tuesday to defend the federal and state health care reform efforts during his six years in office. He said Vermont Health Connect, the state’s online health insurance marketplace created under the federal Affordable Care Act, is finally working as anticipated when it launched in Oct. 2013. “I personally believe that Vermont now has among the best functioning state exchanges in America and probably the best functioning state exchanges in America,” the governor said. The open enrollment process, which has struggled in past years as technology faltered, is “proceeding smoothly,” Shumlin argued. Continue Reading →

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Lunge heading to Green Mountain Care Board

MONTPELIER — Gov. Peter Shumlin has appointed Robin Lunge, one of the top health care reform advisors in his administration, to the Green Mountain Care Board. Lunge, Shumlin’s director of health care reform since 2011, will replace Dr. Allan Ramsay, whose term expired in late September, on the five-member board. Lunge will begin serving her six-year term on Nov. 28. The board has regulatory authority over hospitals and insurance companies and is responsible for controlling the growth rate of health care spending. Continue Reading →

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Green Mountain Care Board backs all-payer model

MONTPELIER — The Green Mountain Care Board on Wednesday voted to advance a draft agreement with the federal government that seeks to transform the way health care providers are paid in Vermont, paving the way for the state and federal government to begin implementation. Gov. Peter Shumlin and his top health care officials negotiated for nearly two years with the federal government on the so-called all-payer model. It will be based on the Accountable Care Organization model — groups of doctors, hospitals and other health care providers that come together to provide coordinated care. The concept is intended to provide better information about a patient’s medical history among providers. The all-payer model includes private insurance as well as government programs like Medicaid and Medicare as payers. Continue Reading →

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JFO: All-payer health care model has risks

MONTPELIER — Several risks and concerns have been raised at recent meetings and hearings about the health care payment reform plan sought by Gov. Peter Shumlin, according to the Legislature’s Joint Fiscal Office. Shumlin, who will leave office in early January, is seeking to transform the state’s health care payment system from the current fee-for-service, where providers are paid for each service or procedure they perform, to one where providers are paid for based on health outcomes. The Shumlin administration has negotiated with the federal government for about two years and has a draft agreement in place. The Green Mountain Care Board, the state’s heath care regulatory body, may vote on the draft agreement as early as Thursday. That would set the stage for Shumlin and the federal government to sign the agreement. Continue Reading →

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State, feds reach deal on all-payer model

MONTPELIER — Vermont has reached a deal with the federal government to move forward with a plan to overhaul the way health care is paid for in Vermont by basing payments to providers on the quality of health outcomes rather than the volume of services they provide, Gov. Peter Shumlin announced Wednesday. Shumlin, a Democrat whose tenure in office will end in January after three terms, has been seeking the transformational shift in the state’s health care payment system for more than two years. Negotiations with the federal government have resulted in a draft agreement that will now be presented to the public for review before the state and federal government sign off on it. “We have now a draft agreement from the federal government that will allow us to take on a challenge that I believe effects the pocketbooks of every single Vermonter,” Shumlin told reporters at a news conference Wednesday. “This is probably the single thing that hurts Vermonters the most economically. Continue Reading →

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Story + Podcast: Shumlin narrows focus in final months

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Listen: Capital Beat Podcast with Gov. Peter Shumlin

MONTPELIER — With just three months left in office, Democratic Gov. Peter Shumlin says he plans to push hard to complete a handful of projects before his successor is sworn into office in early January — including an overhaul of how the state pays for health care services. Shumlin, who is not seeking re-election after his third term expires, reflected in an interview about his time in office and pledged to continue his work until his final day as governor. “This is the best job that anyone can ask for, being governor of Vermont. It’s been an extraordinary privilege. One thing that governors do every day is focus on what they were elected to do, which is to grow prosperity, grow jobs, make sure our state remains the best place to live and work and raise a family. Continue Reading →

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Blue Cross Blue Shield: Vermont Health Connect owes $6.2 million

MONTPELIER — Blue Cross Blue Shield of Vermont is seeking $6.2 million from the state for premiums the insurer did not receive and claims it paid out after the state had terminated individual insurance plans, according to the company and state officials. BCBS and the state are engaged in a reconciliation process to settle the books for health insurance plans sold on Vermont Health Connect, the state’s online health insurance exchange, during 2015. It is the second year that reconciliation is taking place. The state paid $1.6 million to settle the book of business in 2014. A public records request made by the Vermont Press Bureau seeking documents related to the 2015 reconciliation process was returned by the Department of Vermont Health Access, but all 125 pages had all relevant information related to the request redacted. Continue Reading →

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