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IN THE STATES: The Hills Are Alive With the Sound of Health Reform in Vermont

We've seen bloggers' careers ruined by focusing only on all things Massachusetts. We write frequently on the health reform efforts of the Bay State, but it's important not to lose sight of the myriad state initiatives occurring across our country. So today we look at Vermont, whose health reform efforts are featured in the latest Annals of Internal Medicine (subscription).

If there's a recipe for health reform, two major ingredients have to be bipartisan compromise and a comprehensive approach that addresses the interrelated issues of cost, coverage, and quality. Both ingredients were in the mix in May 2006 when Vermont enacted its latest reform efforts.

Building on decades of prior work, the Republican governor Jim Douglas worked with the Democratic legislature to pass a series of reforms centering on the Health Care Affordability Act (Act 191). As Kenneth Thorpe, who consulted on the reform, noted in Health Affairs (subscription), "The Vermont plan passed because of and not in spite of its comprehensive approach for reforming health care." AIM's four-page spread on Vermont provided a nice overview of how it addressed the following issues:

  • Covering the uninsured: The legislation created Catamount Health to provide subsidized coverage for Vermont's uninsured with incomes below 300 percent of the federal poverty level. Vermont expects to enroll 8,800 people by the end of the fiscal year. Coupled with premium assistance and enrollment outreach for existing programs, Vermont aims to insure 96 percent of the state's 65,000 uninsured (about 10 percent of the population) by 2010. If it falls short of this goal in 2010, the legislature will consider an individual mandate—requiring its residents to purchase coverage.
  • Controlling costs: Reformers emphasized the need to make health care more affordable while making it more available. They focused on chronic disease (accounts for 70 percent of the $3.3 billion spent on health care in Vermont) and funded pilot projects of an "accountable care organization" model of payment (outlined by Elliot Fisher in Health Affairs) that realigns incentives so that providers themselves share in savings from a more integrated and coordinated system of care.
  • Improving quality: Vermont's focus on chronic disease is as much about improving quality as it is reducing costs. The state's Blueprint for Health implements a chronic care model developed by the Institute for Healthcare Improvement that has been shown to improve both clinical outcomes and quality of life for patients. Additionally, the Vermont Information Technology Leaders have overseen pilot programs to expand the use of electronic medical records and medication histories to reduce errors and improve quality.

Thinking about the lessons of Vermont's health reform, we couldn't help note some of the parallels to another one of the state's most famous products: the jam band Phish. Phish fused elements of a variety of music (rock, jazz, bluegrass, funk, the list goes on) to achieve an elaborate sound filled with improvisations. Vermont's health reform melds cost, coverage, and quality to in effort to achieve its own health care harmony. Both Phish and health reform play well in front of large audiences. Phish's fanbase spread out from the Green Mountains across the United States. Similarly, we hope to see some of the reforms from Vermont, particularly on chronic disease, payment reform, and health IT occur at a national level.