VAHHS Board Meeting January 11, 2017 Capitol Plaza (Montpelier Room)

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1 VERMONT ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS ENC. 1.0 VAHHS Board Meeting January 11, 2017 Capitol Plaza (Montpelier Room) Roll Call: Thomas Dee, Southwestern Vermont Health Care, Chair Jill Berry Bowen, Northwestern Medical Center, Vice Chair Steven Gordon, Brattleboro Memorial Hospital, Secretary/Treasurer Judy Tartaglia, Central Vermont Medical Center (Proxy Cheyenne Holland) Art Mathisen, Copley Hospital (Proxy Rassoul Rangaviz) Dan Bennett, Gifford Medical Center Louis Josephson., Brattleboro Retreat Roger Allbee, Grace Cottage Hospital Claudio Fort, North Country Hospital Paul Bengtson, Northeastern VT Regional Hospital (Proxy Bob Hersey) Joe Perras, Mt. Ascutney Hospital and Health Center Fred Kniffin, Porter Medical Center Thomas Huebner, Rutland Regional Medical Center Tim Ford, Springfield Hospital Eileen Whalen, The University of Vermont Medical Center John Brumsted, The University of Vermont Health Network Alfred Montoya, Veterans Affairs Medical Center Kathleen McGraw, Trustee Todd Gregory, Trustee Vacant, Trustee VAHHS Staff and Others: Devon Green, Michael Del Trecco, Judy Stermer, Martha Buck, VAHHS; Anne Cramer, Legal Counsel; Guests: Laura Pelosi, MMR; Meg O Donnell, UVMMC. 1

2 Welcome/Introductions Mr. Dee welcomed Joe Perras, Mt Ascutney s new CEO and Judy Stermer, VAHHS new Director of External Affairs. He also welcomed Rassoul Rangaviz (CH), Bob Hersey (NVRH) and Cheyenne Holland (CVMC), proxy on behalf of their CEOs. Introductions were via roundtable. Consent Agenda - January Board Minutes (Enc.1.0) - VAHHS October Financials (Enc. 2.0) -A motion was made to approve the January 11 Board meeting minutes as submitted, So Voted. Mr. Del Trecco on behalf of Mr. Gordon provided the Board with a financial report. He noted that the VAHHS Finance Committee is scheduled to meet February 3, the agenda will include the finalized VAHHS Audit report, a review of fiscal 2018 and VAHHS investments. Mr. Del Trecco will provide a committee report at the February 8 Board meeting. Mr. Del Trecco gave a brief review of the October financials that covered the VAHHS income statement and balance sheet as well as the expenses for October He noted that VAHHS has a strong balance sheet. There were no questions or concerns from the Board. A motion was made to approve the October Financials as submitted, So Voted. Committee Updates: - Legal and Legislative (Enc. 3.0) - Program Education (Enc. 4.0) - (Draft Executive Committee (Enc. 5.0) University of Vermont Health Network (UVMHN) Regional Transport System: Update (Eileen Whalen) Mr. Dee referred members to their board packets for the committee updates. Ms. Whalen referred the Board to the power point in their packets as background to her update. She reported that University of Vermont Network (UVMHN) is currently working with five organizations Central Vermont Medical Center (VT), Champlain Valley Physicians Hospital (NY), Alice Hyde Medical Center (NY), Elizabeth Community Hospital (NY) and the University of Vermont Medical Center on a Regional Transport System. She noted there is no unified transfer center, but rather each hospital has its own transfer and receiving protocols. There are inconsistencies in tracking quality and patient outcomes for both Network and non-network transportation providers. Their 2

3 overall goal is to provide the best method of transport for their patients, in the right location, at the right time, with the right level of service, in a fiscally responsible manner. Ms. Whalen reviewed the guiding principles as well as the design elements. There was a brief discussion about ambulance fleets. She asked members to contact her if they were interested in learning more about the regional transport system and becoming a partnering in this effort. Guest: Optimas (Steve Schramm); Tom Dehner (Boston HMA) and Martin McNamara (Optimas, Phoenix Analyst); Ena Backus, Pat Jones, Melissa Miles (GMCB) Mr. Del Trecco and Mr. Dee welcomed our guests and thanked Mr. Schramm for traveling to Vermont to join us and to continue the APM payment methodology discussion. Mr. Del Trecco provided background of where we left the conversation at our VAHHS October Retreat. Today we would like to drill down more into the health care service areas piece to get a better understanding of what the next steps would entail. Mr. Schramm s presentation covered the key components that were developed for the Green Mountain Care Board that included: data services from VHCURES all-payer claims database (commercial, Medicaid and Medicare); populations were developed for standardized groupings consistent with actuarial practices. He reviewed the categories of service and ACO impact via different populations. Mr. Schramm referenced the Evaluation of CMMI Accountable Care Organization Initiatives report, he recommended that members review the report, it provides findings from performance years one and two as well as gives examples of how other ACOs have been successful. Mr. Schramm noted in developing APM estimates, they found that Vermont s total Medicare per capita expenditures is lower than the national average. Medicare s baseline trend is 4.6% and APM 4.2% Projected baseline expenditures: 3.6% APM vs 3.8% Medicare Discussion moved to sources of savings; hospitals need to focus on what services will have the biggest reductions. Each hospital is different, drill down into your data to see why you are different, all differences need to be factored in. Mr. Schramm asked members to think about population mix, regulatory services, underlying mix of services and what level of risk are you assuming. Investment of savings primary care needs to be a priority. 3

4 Mr. Schramm also presented a review of the HSA analysis structure below; he walked through the different scenarios. Total VHCURES dollars and membership HSA Payer Category of Service (COS) Per Member Per Month (PMPM) Utilization per thousand (Util/K) and Unit Cost Mr. Schramm recommended that hospitals take their data on payers, populations and services and overlay this data to see if things make sense for their hospital. There was a brief discussion about Vermont s network for payers and access issues. The presentation concluded with a discussion of the APM Medicare components that included Vermont Medicare trend-aco, Vermont GMCB Medicare trend Benchmarks and Vermont Medicare trend FFS. Discussion ensued on each component. Members requested a copy of the presentation with definitions of the various terms; Mr. Del Trecco will inquire what data can be shared and will forward the presentation to the board. After the presentation, members discussed the GMCB and Optimas contract and scope of work. Members also discussed briefly the GMCB s Board member issue and how they will leverage. Legislative Outlook (Devon Green & Laura Pelosi) The presentation began with a discussion of the GMCB and Senator Ashe. Ms. Pelosi noted that Mr. Ashe has an obsession with the cost accounting, discussion ensued. She also noted that he has an agenda which he will find a way to move it forward. The role and responsibilities of the GMCB, DVHA and ACO were discussed. It was noted that the GMCB is in a position where they need to justify their role and capacity to the legislature; Senator Ashe sees that their regulatory role may be absorbed by another department in state government; the Scott Administration shares Senator Ashe s perspective. VAHHS has reached out to the Scott Administration, to get a sense of where they are; their message being, get comfortable with discomfort, it s going to 4

5 be a long process, with an all new nominating committee being put together. It was also noted that VAHHS has a collaborative relationship with the GMCB that is very productive, but there is a difference between collaborative and cozy. Now that Mr. Gobeille is gone, the GMCB is trying to get their bearings. It was also noted that the DVHA s role remains unclear; Ms. Pelosi noted that Cory Gustafson is the new DVHA Commissioner. There was also a brief discussion regarding VITL s struggle with its role, capacity and whether hospitals are benefiting from VITL s work. Ms. Green walked through the changes in leadership as well as the changes within the Vermont House and Senate committees; she and Ms. Pelosi voiced their thoughts, concerns with the changes and what they anticipate for the upcoming session. The Vermont Legislative landscape was discussed. Mental Health is going to be a big issue; members discussed their views/concerns and agree we need a collective voice on this crisis, approaching it from a broader perspective than just the ER problem. Mr. Dee suggested that we bring the mental health issue to the Executive Committee to put together a game plan (Mr. Josephson to be included). Ms. Green reported that Jennifer Costa of WCAX is doing an investigative report about mental health, wait times and emergency room care etc. She noted that VAHHS strategy is to be proactive and collaborate; we will arm hospitals with talking points including the message that we know this is a problem, this is what we are doing and here are possible solutions. Ms. Green is working on a public facing document as well, that she will be sharing with the CEOs ASAP. Ms. Green also provided an update on: -Duty to warn (S.3) working w/committee, feeling confident that we will overturn the Kuligoski court case. -Opioid abuse Human Services is keeping this issue Ms. Green is working with Vermont Department of Health on education and outreach. It may be possible to revisit the rule under a new administration. -Public Meeting Forum -ACOs (S.4) (bill introduced by Ginny Lyons) Ms. Green noted this broad public session requirement only applies to ACOs but could be expanded to hospitals if they do not have a public session policy in place. Looking for hospitals that haven t already, to adopt an open meeting policy in a proactive move (to be prepared for when the legislature inquires what hospitals are doing). Please forward those policies to Ms. Green ASAP. 5

6 Other: -Go Red for Women (Jill Berry Bowen) -Rise Vermont (Jill Berry Bowen) Executive Session Ms. Green and Ms. Pelosi walked through the known legislation, update included: -Sugar sweetened beverages Supporting as an Association -Telehealth for psychiatry Ms. Green will information to hospitals -Legislation requiring circulating nurse for the OR -Vital Records: 5 calendar days, but statewide electronic directory -Expanding Vermont Practitioner Recovery Network to include mental health issues. -Provider Tax - Ms. Cramer reported that the provider tax has been withdrawn last week, per supreme court. Ms. Berry Bowen reported that the Go Red for Women luncheon is on Thursday, January 26 to benefit American Heart Association. She asked members if they have not sponsored before it s not too late to do so for this great cause. Ms. Berry Bowen also reported that, via transformational fund, only for ACO application, ACO wants to take Rise Vermont statewide. She noted that Rise Vermont is a movement, not a replacement of what you are currently doing. She also noted that the committee is putting together a corporation to get transformational funds; goal of accelerating outcomes within the communities. Ms. Berry Bowen welcomed further discussion /questions offline with members. There was not a need for an Executive Session. Adjournment: Mr. Dee adjourned the meeting at 12:00. Meeting Schedule: February 8 in the Capitol Plaza Hotel 6

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