Rewarding good health
State rewards doctors and hospitals for wellness push
Vermont tries a new approach to health care, focusing on prevention.
The underlying premise: Reward doctors and hospitals financially when patients are healthy, not just when they come in sick.
ENOSBURG FALLS, Vt.— Doug Greenwood lifted his shirt to let his doctor probe his belly, scarred from past surgeries, for tender spots. Searing abdominal pain had landed Greenwood in the emergency room a few weeks earlier, and he’d come for a follow-up visit to Cold Hollow Family Practice, a big red barnlike building perched on the edge of town.
After the appointment was over and his blood was drawn, Greenwood stayed for an entirely different exam: of his life. Anne-Marie Lajoie, a nurse care coordinator, began to map out Greenwood’s financial resources, responsibilities, transportation options, food resources and social supports on a sheet of paper.
A different picture began to emerge of the 58-year-old male patient recovering from diverticulitis: Greenwood had moved back home, without a car or steady work, to care for his mother, who suffered from dementia. He slept in a fishing shanty in the yard, with a baby monitor to keep tabs on his mother.
This more expansive checkup is part of a pioneering effort in this New England state to keep people healthy while simplifying the typical jumble of private and public insurers that pays for health care.
The underlying premise is simple: Reward doctors and hospitals financially when patients are healthy, not just when they come in sick.
It’s an idea that has been percolating through the health care system in recent years, supported by the Affordable Care Act and changes to how Medicare pays for certain kinds of care, such as hip and knee replacements.
But Vermont is setting an ambitious goal of taking its alternative payment model statewide and applying it to 70 percent of insured state residents by 2022.
“You make your margin off of keeping people healthier, instead of doing more operations. This drastically changes you, from wanting to do more of a certain kind of surgery to wanting to prevent them,” said Stephen Leffler, chief population health and quality officer of the University of Vermont Health Network.
Critics, however, worry that it will create a powerful tier of middlemen charged with administering health care payments without sufficient oversight.
Those middlemen are Accountable Care Organizations, networks of hospitals and doctors that work to coordinate care and can share in the rewards if providers are able to save health care costs, but remain on the hook if costs run too high.