BASIC FRAMEWORK Healthcare reform is being implemented across the U.S. This was done in an effort to reduce spending on Healthcare and increase quality Healthcare spending has increased by 10% from 1971 and is now at $2.5 trillion
BASIC FRAMEWORK A larger portion of the U.S. population is uninsured or underinsured About 50,000 people in Vermont are uninsured and 150,000 are underinsured Due to this Governor Shumlin has set four overarching goals and a total of sixteen strategies to improve these conditions
BASIC FRAMEWORK Goal 1: Reduce health care costs and cost growth 1. Develop a health care budget that is economically sustainable 2. Reduce administrative cost 3. Implement innovations for payment design and encourage providers to reduce costs of care 4. Better manage care for individuals with chronic conditions 5. Maximize federal funding to support coverage of health care services in Vermont
BASIC FRAMEWORK Goal 2: Assure all Vermonters have access to and coverage for high-quality health care 6. Cover uninsured individuals7. Increase enrollment and retention in coverage8. Assess adequacy of health care workforce9. Define a minimum standard of benefits
BASIC FRAMEWORK Goal 3: To improve the health of Vermont’s population10. Assure all individual have access to high quality and coordinatedpreventative services by improving the integrated health services model11. Evaluate and improve health care delivery by expanding the learninghealth system12. Assure access for all working individuals to healthy worksites,employee assistance and other community support for healthmanagement13. improve the health of school children by implementing theCoordinated School Health Model recommended by the CDC14. Support Vermont communities to respond to specific public healthchallenges
BASIC FRAMEWORK Goal 4: To assure greater fairness and equity in how we pay for healthcare 15. Gain passage of legislation and approval of a federalwaiver for public financing that is separate from employment andgives individuals the ability to pa for coverage that is moresustainable16. Reduce cost shifting between public and private sectors andbetween segments of the private sector
HOUSE BILL 202 (H202) Governor Peter Shulman signed House Bill 202 on May 26, 2011 which implemented a single-payer health system in Vermont Single-payer systems are based on residency, which creates natural mechanisms for universal coverage
SINGLE-PAYER SYSTEMS Basic benefits provided to all citizens through one publically financed insurance fund which pays providers under uniform mechanisms and rates Funded through payroll taxes and includes generous benefit packages. Payroll taxes are split 75 percent for employers and 25 percent for employees, with exemptions for small businesses and low-wage workers and families with income below 200 percent of the federal poverty level
MEDICAID AND MEDICARE Medicaid and Medicare are to function as before Goals of Vermont Health Care reform include maximizing coverage by Medicaid and encouraging those eligible for Medicaid to enroll for coverage
COST OF THE PROGRAM Main goal is to reduce the overall cost of Healthcare Vermont spends $5 billion on its healthcare currently, and that money needs to be spent in a more smart way. Smart ways to spend the $5 billion dollars to make sure healthcare is more efficient in future. The state has various goals and strategies to help them with cost reduction
COST OF THE PROGRAM $400 million in tax credits will take some of the burden off Application to the state government was submitted for $118 million Vermont is moving away from the traditional “fee-for-service” method “Global budget methods are being introduced”
COST OF THE PROGRAM Four main Goals of the new Health care
COST OF THE PROGRAM Goals Reduce Healthcare Cost and Cost Growth Assure that all Vermonters have access to and coverage for high quality care Assure greater fairness and equity Improve the health of the Vermont’s population Each goal has various strategies.
ACCESS TO HEALTHCAREhttp://nhop.org/wp-content/uploads/2010/09/Improving-Access.jpg. Cached: February 27,2013. Accessed: March 9,2013
ACCESS TO HEALTHCARE Number of Uninsured Vermont: 55,300 10% of the state population United States: 47,921,500 18% of the national population
ACCESS TO HEALTHCARE Increasing the insured population PPACA insurance market http://healthconnect.vermont.gov/
ACCESS TO HEALTHCARE Evaluate and improve the healthcare workforce Senator Bernie Sanders’ (VT) Plan Currently there are 8 Community Health Centers for 11 counties in Vermont. Each County should have its own Health Center.
ACCESS TO HEALTHCARE Minimum Standards of Care Set a baseline of care which will be covered under all insurance plans. Provides at least a minimum of service for individuals to maintain a healthy life style. Promotes preventive health practices to lower the costs of care.
EFFECT OF THE PROGRAM Employers Employees Providers Uninsured
EFFECT OF THE PROGRAM PROVIDERS o Reductions in administrative tasks for physicians and other healthcare providers. o Increased focus on the delivery of Quality care. o Increased autonomy in clinical decision-making Best medical practice vs. Patient’s financial conditions o Decline in overhead expenses o Potential for Reduced malpractice premiums
EFFECT OF THE PROGRAM EMPLOYERS o Reduction in financial burden on employers. Lower insurance premiums leads to increased financial resources o Creates a level playing field for all businesses, in terms of healthcare financing o Prevents the shifting of costs to employers Lower insurance premiums
EFFECT OF THE PROGRAM EMPLOYEES o Increased access to health care for people. Removal of financial barriers o Increased quality care via preventive services. o Autonomy in choosing healthcare providers and health plans. o Portability of health coverage plans Health coverage remains constant even when people change jobs, change marital status or relocate to different homes.
EFFECT OF THE PROGRAM UNINSURED o Access to health care Vermont’s single-payer system covers everyone regardless of their age, income and employment status, thus ensuring that the rate of uninsured people is significantly reduced or eliminated in the state
LITERATURE CITED Bernie sanders u.s. senator for vermont: Health care. (2013). Retrieved from http://www.sanders.senate.gov/legislation/issue/?id=a5823331-b1c8-46a1-864f-a5986cf82a9b Insurance Journal (July, 2012). Vermont Governor Hails Healthcare Ruling, Pushes Bigger Plan. Retrieved from: http://www.insurancejournal.com/news/east/2012/07/02/254158.htm Lunge, R. J. (2012). Strategic Plan for Vermont Health Reform. Vermont.gov. Retrieved from http://hcr.vermont.gov/sites/hcr/files/Strategic%20plan%201%2016 %2012.pdf Single Payer 101: Vermont for Single Payer . (n.d.). Home :: Vermont for Single Payer . Retrieved March 8, 2013, from http://www.vermontforsinglepayer.org/single_payer_101 Vermont (2013). Vermont’s Health Care Reform- Agency of Administration. Retrieved from: http://hcr.vermont.gov/goals/reduce_costs Vermont health connect. (2013). Retrieved from http://healthconnect.vermont.gov/ Vermont: Nonelderly uninsured. (2011). Retrieved from http://www.statehealthfacts.org/profileind.jsp?sub=40&rgn=47&cat=3