Kept in the dark, senior health-advocacy groups are unsure how to advise uninformed seniors about potential Medicare changes coming through the all-payer health care system.
“We as … community based service providers were left out of the all-payer waiver development meetings,” said Sandra Conrad, executive director of Southwestern Vermont Council on Aging.
“Will it be beneficial or harmful is the million dollar question because we don’t know what is being proposed,” she added.
The Green Mountain Care Board is engaged in discussions with the federal government to set payment rates for Medicare, Medicaid and private insurers as part of an “overall population health” strategy. This system moves away from the traditional fee-for-service payment model for health care. Instead of being paid per procedure, providers will be given a yearly budget which they cannot go over.
If providers exceed their budget, they may be faced with fines. If they stay under, the provider will split the profit with their overseeing Affordable Care Organization, a governing body which assigns set amounts to individual providers under their jurisdiction after receiving overall budget plans from the GMCB.
Conrad says home-care groups like hers have yet to see adequate health care funding.
“Where are the health care dollars to support home (and) community based services? It is just assumed that agencies like the Council on Aging will always be there. The truth is our foundation is crumbling because of years of level funding while the elder population in Vermont continues to grow,” she said.
Vermont is the second oldest state in the nation, with more than 20 percent of its residents receiving Medicare benefits. At over a fifth of Vermont’s population, seniors represent a significant health cost that, if not properly accounted for, can wreak havoc on Vermont’s health care reform.
Al Gobeille, chairman of the Green Mountain Care Board, has stressed since the beginning of the all-payer application that all provider groups were being included in discussions.
However, Beth Stern, executive director of the Central Vermont Agency on Aging says otherwise.
“It’s very complex and much of the negotiations have been done in secret. … The whole process needs to be more transparent,” she said. “Lawmakers need to realize that non-medical services are vital to the success of health care reform.”
The GMCB is stressing preventive care in its reform and incentive plans — a strategy that hopes to cut medical costs through promotion of healthy living and preemptive screenings.
“If hospitals and ACOs want to keep people out of nursing homes and emergency rooms, they need to recognize that much of health care happens at home, such as home delivered meals, transportation (and) homemaking,” Stern said. “If these things are not successfully paid for … the chance of success for seniors is much lower and the cost of health care is higher.”
Gini Milkey, executive director for the Community of Vermont Elders, agrees. “Older folks need long-term care,” she said. “ACOs operate on a medical model, but senior … patients need in-home care, typically run through special service models. We don’t know how this will interface with the new organization.”
Vermont AARP has not yet announced its position on the all-payer waver, but any statement could heavily influence public opinion on the controversial reform.
Regardless of official positions, seniors will soon realize how important the all-payer waver is for their care. “We hope that they still have choices, still have the services they need,” Milkey said. “We can only hope.”
Contact Emma Lamberton at [email protected]