By Michael Bielawski
The State of Vermont and two other states are entering into a federally-funded healthcare collaboration promoting “equity” in healthcare.
The language implies that participating states may allow some citizens priority to healthcare resources because they belong to ‘underserved communities.’
A news release by the Centers for Medicare & Medicaid Services states, “On July 2, 2024, CMS announced that Connecticut, Maryland, and Vermont will be the first state participants in the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. Hawaii will also participate, pending satisfaction of certain requirements.”
AHEAD has three main goals: “Improve overall population health of a specific state or region,” and ”advance health equity by reducing disparities in health outcome,” and “Curb the growth of health care costs.”
More specifically, the statement says “AHEAD [All-Payer Health Equity Approaches and Development] encourages a state level, multi-sector approach to care, advancing health equity and thereby improving population health outcomes, and coordinating resources to address underlying factors that contribute to disparities in health outcomes in underserved communities.”
It’s not yet clear how these disparities will be directly addressed. In the past, the State of Vermont set a precedent to allow prioritized healthcare by race. For example, in 2021 the Green Mountain State prioritized vaccine distribution based on race.
Financial incentives
The presser continues to explain that states entering into this program will receive extra federal funding, but only if certain conditions are met. The language specifically says that states “will be held accountable” for “equity targets” to get their money.
CMS states, “The AHEAD Model is scheduled to operate for a total of 11 years, from 2024 through 2034. CMS will provide cooperative agreement funding to selected states for up to 6 years to support their participation in this Model. A maximum of 12 million dollars may be awarded to each participating state.”
Another section further specifies, “As part of the model, participating states will be held accountable for statewide or sub-state targets that align with model goals for Medicare FFS and across all payers. States will also be responsible for ensuring that statewide quality and equity targets for all residents are being met.”
It somewhat clarifies the equity targets: “States will be required to establish a model governance structure to guide implementation of the model. Through this structure, states will convene individuals and organizations with a wide range of perspectives to inform model activities and build partnerships between the state, providers, payers, and the community to support model goals.”
Participants who go further with their state health equity plans might have access to additional “bonus” money. It states, “The Health Equity Improvement Bonus will provide an upward adjustment to a participating hospital’s global budget based on performance on select equity-related measures.”
It continues that a “Statewide Health Equity Plan” must be developed by each participating state and other details.
Economy of scale
As with other multi-state collaborations on public services in the past, part of the logic for its implementation is that having a larger multi-state population means a greater economy of scale. That means proponents hope to bring down costs.
“AHEAD is a state total cost of care (TCOC) model that seeks to drive state and regional health care transformation and multi-payer alignment, with the goal of improving the total health of a state population and lowering costs,” it states.
It continues, “Under a TCOC approach, a participating state uses its authority to assume responsibility for managing health care quality and costs across all payers, including Medicare, Medicaid, and private coverage.”
Return of the failed “All-Payer” model?
Vermont’s lawmakers in the past have already thoroughly examined the economic viability of what was dubbed the “All-Payer” model. After much debate, it was ultimately determined not viable fpr the economy.
Meg Hansen, the former executive director of Vermonters for Health Care Freedom, was an adamant critic of the proposal.
“Vermont tried to do the single-payer model [also the ‘all-payer’ model] … under Democrat Gov. Peter Shumlin,” Hansen was quoted by the Heartland Institute in 2019. “He made it the hallmark of his administration. In 2011, the Green Mountain Care Board—five bureaucrats that now determine all regulations for Vermont—was created to oversee and regulate the entire process. But the whole thing collapsed. It failed. They ran the numbers: There was a 150 percent increase in income tax on Vermonters and it still wasn’t enough [money].”
This policy in its FAQ section features the phrase “all-payer” hinting that this policy could push Vermont back toward a large healthcare system potentially similar to the one previously determined unfit for Vermont.
It states, “The AHEAD Model requires participating states to collect and report statewide quality, health equity, and all-payer TCOC [total cost of care] and primary care investment performance data.”
The author is a writer for the Vermont Daily Chronicle
The post Vermont joins federal pilot promoting health care ‘equity’ first appeared on Vermont Daily Chronicle.
The post Vermont joins federal pilot promoting health care ‘equity’ appeared first on Vermont Daily Chronicle.
