[{"_1":2,"_99":-5,"_100":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,75,87],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},"mediaId",6359480,"mediaKeyId","2177236-b6438fdff41c970bf7e09377d0593369","parentId",2177236,"title","Cathedral Square outlines SASH expansion and pilots, cites Medicare savings and eviction prevention","audioSeconds",1572,"startMs",5778000,"endMs",7350000,"viewUrl","/Search/View?dp=1&key=2177236-b6438fdff41c970bf7e09377d0593369&start=5778&end=7350","thumbnailUrl","https://assets.pipeline.soar.com/2177236-b6438fdff41c970bf7e09377d0593369/thumbnail_5778000.jpg","articleUrl","/articles/6359480/Vermont/Cathedral-Square-outlines-SASH-expansion-and-pilots-cites-Medicare-savings-and-eviction-prevention","mediaUrl","https://secure.pipeline.soar.com/6359480-678f1995911edc869862deaa64280b22/orig.mp4?Expires=1771150877&Signature=a5Dieyopd05j1pEw6HGHIp1lRgAtPqr4twd10nuxcN8dPxs~-Arp~s6sTstkhfMCZLIL-2rSxT-ZmPFXBvAXWpezxGuR1lroEvUMjn7cio6x6POdwl2yuJaIsD~2G~Awd-dLdBDQA13zR2v5xXVos2xUCxaTGF3z6-cCcx05SH4ygjll3zRl49nBZU6woIufK6MGTzq3fl3TtP37K6milHHv2j7eo4wqG6GRcrPp-A8nXCBNzBVYxKIWvfiVNIMAwKa7fK3zBAcTBEyXgj8-ctRhXCt5U1QJfbY6S-uASAWMkO78tbH47vWlbTfMYM9omyUOjS5O~MkK7uCQx-~3OQ__&Key-Pair-Id=KUT5TJCACFTXG","author","","date","2025-01-31T18:06:03Z","article","Kim Fitzgerald, chief executive officer of Cathedral Square, and Liz Genge, director of SASH, briefed the Health Care Committee on the program's 15-year history, current scale and new pilots that extend supportive services beyond congregate older-adult housing.

Fitzgerald said SASH began as a resident-driven pilot in 2009 at Cathedral Square's Heidenberg property and expanded after that initial demonstration showed reduced emergency-department use. The program pairs a SASH coordinator and a wellness nurse for panels of roughly 70 to 100 people; the pilot levels were about 40 hours of coordinator time and 10 hours of wellness nursing per panel. The program later joined the Blueprint and received Medicare funding through the multi-payer advanced primary care demonstration, and it now operates under the state's payer arrangements.

Fitzgerald said SASH panels were historically capped at 54 panels statewide and modest payment updates over time allowed expansion to 57 panels; SASH now serves about 5,000 participants and Cathedral Square estimates more than 12,000 people have engaged with the program since inception. A third of participants are Medicare, a third Medicaid and a third commercial payer mix in recent reporting, Fitzgerald said.

Fitzgerald and Genge cited an independent evaluation that found average Medicare savings of about $1,400 per participant and an estimated Medicaid savings of roughly $400 per participant in the study period. The pair emphasized that SASH serves a medically complex population: more than 85 percent of participants have three or more chronic conditions and the program's average participant age is in the early-70s.

Genge described ongoing pilots: integrating mental-health clinicians into panels (multiple counties) and a SASH-for-All model in Brattleboro that serves multifamily, mixed-age affordable housing. In Brattleboro the team prevented 19 evictions to date, ran more than 160 social-connection activities, and logged over 1,300 clinician visits in the first year of embedded behavioral-health staffing. Genge said 87 percent of adults in the Brattleboro pilot qualify for Medicaid and 87 percent reported food insecurity.

Fitzgerald said SASH's accessible, in-home approach allows wellness nurses to do Medicare annual wellness visits under a OneCare participation waiver pilot and to coordinate with partner primary-care practices using shared electronic records in those pilots.

Committee members asked about funding sustainability and threats. Fitzgerald said long-term funding has been a recurring challenge because the program relies on multi-payer PMPM payments that have not always increased with costs; modest historic increases and sequestration-era cuts reduced per-panel funding, and SASH leaders said they need predictable increases to expand successful pilots. She urged that the AHEAD model or state budget include steady support to protect and scale SASH operations.

Fitzgerald closed by noting SASH's replication in other states and the program's potential fit under future statewide payment models, while warning that funding uncertainty poses the biggest threat to sustaining and expanding proven services.","mediaType","Video","parentTitle","House Healthcare - 2025-01-31 - 1:00 PM","oneSentenceSummary","Kim Fitzgerald and Liz Genge described SASH's origins at Cathedral Square, program scale, and new pilots including SASH for All in Brattleboro and embedded mental-health clinicians; third-party evaluation showed Medicare savings averaging about $1,400 per participant.","taxTitle","Health Care, HOUSE OF REPRESENTATIVES, Committees, Legislative , Vermont","taxId",30956,"location","Vermont","headline","shortSummary",{"_33":76,"_35":36,"_37":38,"_39":77,"_41":78,"_43":79,"_45":80,"_47":81,"_49":82,"_51":83,"_53":84,"_55":56,"_57":58,"_59":85,"_61":62,"_63":64,"_65":86,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},6359484,"Blueprint for Health official outlines statewide patient-centered medical home network and community health teams",1810,3962000,5772000,"/Search/View?dp=1&key=2177236-b6438fdff41c970bf7e09377d0593369&start=3962&end=5772","https://assets.pipeline.soar.com/2177236-b6438fdff41c970bf7e09377d0593369/thumbnail_3962000.jpg","/articles/6359484/Vermont/Blueprint-for-Health-official-outlines-statewide-patient-centered-medical-home-network-and-community-health-teams","https://secure.pipeline.soar.com/6359484-43bbfa27c73a9c1a711e536683f525d2/orig.mp4?Expires=1771150877&Signature=lHjqdix0cKmai7QX09o7QSVKPZlGxR-rDMwykcRrTfRhbgf-qShmHXqZxK~0yOD1OPP2E9084urbYlPfmzV22qE5DmQvu6rquiiLis7LkTPMHTQOjnbr~RMpEwmc2JCFORocD~TQcqquesxyAccWdPks16I5gXM7moj3MG8nRMR37getnP2mxwD2CkmLhY7nPeMnX9Pbxikn8rutcRp3jA~4uXeansOqfEaUMQytXTpbZWfWU2WH40YfqIlciAWppyLyXH~1zDpGzZvuCtOlJJLQSrUP~Nq2Us3veqfSnUG7A~U3rrrVqe3YgICWJqky08C6~WmdYgj6RAos2zzu3A__&Key-Pair-Id=KUT5TJCACFTXG","John Saroyan, executive director of the Blueprint for Health, told the Health Care Committee that the statewide program centers on patient-centered medical homes, multidisciplinary community health teams and value-based per-member payments that pay for team-based supports without point-of-service billing to patients.

Saroyan said the Blueprint was codified in state statute, piloted in 2008, and expanded statewide through subsequent legislative action. He described the program's four primary initiatives: recognized patient-centered medical homes, community health teams that provide social supports and care coordination, the hub-and-spoke medications-for-opioid-use-disorder system, and a pregnancy-intention initiative that expands access to family-planning services.

Saroyan summarized how the program is funded: large commercial insurers, Medicaid and Medicare pay prospective per-member-per-month amounts into the Blueprint. He told the committee that the standard patient-centered medical home payment is roughly $3 per member per month and community health team funding is approximately $2.77 per member per month; those perspective payments are designed to support teams and are not billed directly to patients. \"There's no claim generated. I don't get a bill,\" he said of community health-team visits.

He described the program's reach and activity: more than 70 percent of Vermonters are seen in Blueprint-supported practices, community health teams have served roughly 26,000 unique individuals with an estimated 75,000 points of contact over about two years, and the program divides the state into health-service areas with administrative entities that oversee local teams.

Saroyan acknowledged funding pressures and market changes he called out in the legislature's Act 51 review, including shifting insurer participation (for example, Medicare Advantage and self-funded plans can affect payers' contributions). He said the legislature has asked the Blueprint to study alternative funding options and that the program is monitoring trends in payer participation.

He also highlighted performance and value: community health teams perform social-screening work, connect patients to housing and refrigeration for medications, and reduce emergency department use in many practices. Saroyan noted the program's quality requirements; participating practices must meet National Committee for Quality Assurance recognition standards for patient-centered medical homes.

Committee members asked about trends in payer participation and the challenge posed by Medicare Advantage and self-funded plans that may not contribute to the Blueprint pool. Saroyan said the legislature's Act 51 report addressed funding options and that staff can return with more detailed trending on payer participation and potential policy responses.

Saroyan closed by citing patient and staff quotes from the Blueprint's annual report to underscore the program's local impact and urged continued legislative support to maintain and adapt the model as payer markets change.","John Saroyan, executive director of the Blueprint for Health, briefed the Health Care Committee on the program's structure, funding mechanism and reach, saying more than 70 percent of Vermonters receive care in participating practices and community health teams have engaged about 26,000 unique individuals.",{"_33":88,"_35":36,"_37":38,"_39":89,"_41":90,"_43":91,"_45":92,"_47":93,"_49":94,"_51":95,"_53":96,"_55":56,"_57":58,"_59":97,"_61":62,"_63":64,"_65":98,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},6359489,"Hospitals tell Health Care Committee AHEAD model and rapid price cuts risk rural services",1519,78000,1597000,"/Search/View?dp=1&key=2177236-b6438fdff41c970bf7e09377d0593369&start=78&end=1597","https://assets.pipeline.soar.com/2177236-b6438fdff41c970bf7e09377d0593369/thumbnail_78000.jpg","/articles/6359489/Vermont/Hospitals-tell-Health-Care-Committee-AHEAD-model-and-rapid-price-cuts-risk-rural-services","https://secure.pipeline.soar.com/6359489-e365ba3f6a2481f639bcda91e0aaf132/orig.mp4?Expires=1771150877&Signature=QMbvlAlIMOSMwF5qWxYajHXgmEdH~x2paQbMId5YBzmYXBJNl~oz2uQ8BJJTi1xZW-c2iIlADS28Z49E2qJtFScyaNA9tFMimaeQUSUSKP1H4v0qxf~PMjVWZbuyoNRk7-F8vM9X~uqmuCZreYYLTcYmEPSWFUPXah-ghc6Ps34aVxO1JiX40~hV~BqMlQ-hOxYy9AL8Xfhy2Jsf5HsON2vnEGVdZdwTUqkD4Lh1CEFmaQGZyXRWwX6oSqrCrk85nQqEXjcBGE5g~puBBx3gUOPStrYfTADj0-tD85gaSVD7uoRslGCsGFRuTM7XrOXntw9cEixiLBowcXHLUXtRcQ__&Key-Pair-Id=KUT5TJCACFTXG","Devon Green, vice president at the Vermont Association of Hospitals and Health Systems, told the Health Care Committee that Vermont hospitals support transformation but warned that the AHEAD federal model offered to replace the state's all-payer approach leaves little room for states to design different payment structures.

Green said the state's hospitals provide uniquely required services — including 24/7 emergency departments governed by the federal Emergency Medical Treatment and Labor Act (EMTALA) — and serve as critical partners in emergency management, supply-chain contingency planning and disaster response.

The association official told lawmakers that critical access hospitals, which federal rules limit to 25 beds and an average length of stay of no more than 96 hours, rely on cost-based Medicare reimbursement. \"Critical access hospitals were designated specifically by the federal government to improve access to health care in rural communities,\" Green said. She noted Vermont has eight critical access hospitals and one Medicare-dependent hospital, Brattleboro Memorial Hospital.

Green cited state data posted by the Green Mountain Care Board showing Medicare reimbursed roughly 85 percent of hospitals' costs in 2023 — below the ideal of full cost coverage — and said Medicare participation is central to any meaningful hospital payment reform. \"Medicare is a big portion of our reimbursement and who pays us. And so Medicare defines a lot of things,\" Green said. She told the committee it is difficult to implement a global-budget approach unless Medicare joins or accepts the state's model because hospitals cannot change practices for the large Medicare patient share otherwise.

The Vermont hospital association also raised concerns about reference-based pricing. Using recent Green Mountain Care Board budget data and assuming a reference-based level of 200 percent of Medicare, Green said hospitals would face substantial revenue impacts. She acknowledged hospitals are exploring reference-based and other options but cautioned the committee that abrupt, uniform cuts \"at 200% too quickly, will have a negative impact on hospitals.\" Green and committee members discussed tailoring reference levels by service type to protect services policymakers want to preserve.

Green criticized a recommendation in a consultant report that rural hospitals with low obstetric volume should close birthing units, saying that the underlying study suggested quality improvement support rather than facility closures. \"I fundamentally disagree with closing birthing and maternal services in rural communities just based on a number,\" she said, adding that Vermont ranks highly for maternal health nationally and that recommendations need more context.

On waivers and federal authority, Green noted the difference between Medicaid 1115 waivers and Medicare policy: \"There are two different things. The AHEAD model is just like innovation. My waivers are Medicaid specific through CMS. They're just two different things,\" she said, emphasizing limited federal flexibility for state-specific Medicare arrangements.

Green urged more technical assistance and local planning before any major payment shifts. She described hospital-led transformation activities already underway — regional collaboratives to improve purchasing power, partnerships to keep patients closer to home after transfers, pilot primary-care alignment and investments in interoperability — but warned hospitals have limited margins and need time and detail to shift services without unintended closures.

Committee members asked for the underlying data and schedules Green used, and Green said the association used Green Mountain Care Board tables and hospitals' 2023 budget actuals to build impact estimates. She said hospital leaders welcome deeper consultation with the AHS-convened consultant and are prepared to participate in transformation work, but need more clarity on how the AHEAD model, Medicare participation and rate-setting would work before implementing major changes.

The discussion made clear that hospitals are both willing participants in transformation and deeply concerned about operational and financial consequences if federal and commercial payer changes are implemented quickly or uniformly.

Green concluded by summarizing hospitals' readiness to engage and their need for clearer federal guidance and technical support: \"We are at the table to do that. But I just wanted to give further context about, just we are very much looking forward to digging into these recommendations and looking at other potential recommendations or things that we can do, to make sure that, again, there is further information, context, and not just a conclusion based on a number.\"","Devon Green of the Vermont Association of Hospitals and Health Systems told the Health Care Committee that hospitals need more technical detail and Medicare participation before the AHEAD model or aggressive reference-based pricing are implemented, warning of risks to rural maternity and other local services.","actionData","errors"]

Article not found

Cathedral Square outlines SASH expansion and pilots, cites Medicare savings and eviction prevention

Blueprint for Health official outlines statewide patient-centered medical home network and community health teams

Hospitals tell Health Care Committee AHEAD model and rapid price cuts risk rural services