Lawmakers weigh new spending and debate integrating clinical and claims data under S126

A legislative working group continued its review of S126 on April 24, with fiscal staff presenting updated appropriation estimates and a broad set of stakeholders testifying about Section 10, which would expand use of an integrated clinical-and-claims data system.

Noel Langdon of the fiscal office told the group the Senate Appropriations language currently on the table would add about $3.5 million in general fund spending and $150,000 from the HIT (health information technology) fund, for a combined proposal of about $3.66 million to support work by the Agency of Human Services (AHS) and the Green Mountain Care Board. Langdon said AHS previously told the fiscal office it needs roughly $5 million overall for the work but that the Senate proposal covers part of that request now.

Supporters and skeptics described competing priorities. Home health and community providers urged better interoperability and EHR (electronic health record) design that supports field workflows; hospital IT leaders and the state’s health information exchange emphasized getting hospitals to share clinical records with each other more seamlessly; and a major insurer opposed merging commercial claims and clinical records in a single, identified database at this time, citing privacy, data completeness and cost concerns.

Why this matters: Section 10 is tied to the state’s effort to reduce administrative burden, improve care coordination and supply data for payment and policy decisions. The fiscal choices before the Legislature determine which pieces of the work get funded now and which are deferred, while technical and governance questions—who can see identified claims, how to limit clicks inside clinicians’ EHRs, and how to protect sensitive information—will affect whether the system delivers the bill’s goals.

Fiscal details and staffing Noel Langdon, introduced as joining the fiscal office for the record, summarized an earlier fiscal note and recent revisions. He said the bill originally carried staffing and funding estimates provided by AHS and the Green Mountain Care Board: those estimates included several new positions and a multi-million-dollar price tag. Under the Senate Appropriations draft Langdon described, the Green Mountain Care Board would add three positions this year (bringing total board positions closer to six when combined with positions already in the Board’s budget) and contract funding; AHS would receive a partial appropriation now and could request the remainder in next year’s budget.

Langdon gave more detail on AHS’s request as transmitted to the fiscal office: AHS told staff it needs about $5,000,000 overall and that the current proposal covers roughly half in the near term. "They told me they need $5,000,000 and but it can be over multiple years," Langdon said. He identified line items AHS described: roughly $2.25 million for a feasibility analysis and development of a transformation plan with hospitals, primary care organizations and community providers; $125,000 to develop quality and access measures and monitoring strategies for a statewide population health plan; and $125,000 to support development of hospital budgets or other alternative payments for Medicaid. Langdon summarized the Senate funding package as "the latest thinking on what the needs would be to implement the bill as proposed." He also reported a closing balance of about $7.4 million in the HIT fund as of the close of fiscal year 2024, noting AHS had not provided an up-to-date obligation schedule.

Provider and hospital testimony: workflow and usability Home health leaders described why clinical workflow matters for any statewide data effort. Jill Olsen, executive director of the VNAs of Vermont, and Sandy Ruse, chief executive officer of Central Vermont Home Health and Hospice and a member of the state’s health information exchange steering committee, said home-based care differs materially from clinic or hospital settings and that many home health EHRs are designed specifically around federally mandated home-health assessments.

Sandy Ruse said home health clinicians "have an EHR that actually is a hospital based system with a home health module. It does not support our workflow. It is not intuitive." Ruse and Olsen described clinicians documenting brief, clinically pertinent items in patients’ homes—often offline on tablets or laptops—and said systems that require extensive clicks or force users to leave their primary EHR to view exchange data make the tool less useful in practice.

Hospital representatives and the state HIE Devin Green of the Vermont Association of Hospitals and Health Systems and Emma Harrigan, vice president of policy for the association and chair of the HIE board, emphasized hospital-to-hospital interoperability as the immediate priority. "We are much less concerned about that. We are more laser focused on interoperability between hospitals," Green said, urging initial emphasis on connecting hospital EMRs and improving the user experience so clinicians can access HIE data from within their local EHR.

Harrigan said the state HIE already has broad coverage and that the practical barrier for many clinicians is the user experience: some hospital sites can access exchange data inside their EMR as an integrated tab while others must log into a separate portal. She characterized development work as ongoing and recommended prioritizing where improvements would yield the most benefit.

Support from community health and primary-care groups Mary Kate Wollman of Bi-State Primary Care Association said community health centers use linked clinical and Medicaid claims for operational quality improvement and panel management, but cautioned that integrated datasets must be packaged as actionable information rather than raw tables. Wollman said the most useful near-term products are practice-level reports and analytics that health centers can use to run recall, reconciliation and care-management workflows.

Vermont Care Partners representatives also urged robust governance and careful rollout. Simone Rishmeier, executive director of Vermont Care Partners, noted designated agencies are connected to a separate repository and stressed that governance, privacy protections and clear user experience requirements are essential before expanding data sharing.

Insurer concerns about integrating claims and clinical data Tara Teachout of Blue Cross and Blue Shield of Vermont told the group the insurer "oppose[s] integrating, commercial health care claims data and clinical records at this time." She listed concerns familiar to the committee: an incomplete claims picture because many self-funded employers do not submit claims to the state database; a 6-to-9 month lag in claims reporting that limits real-time clinical use; costs for insurers and providers to build and maintain interfaces; differentiated federal privacy regimes for mental health and substance-use records; and additional security risk from consolidating identified clinical and payment data in one repository.

Points of agreement and outstanding questions Several witnesses agreed on principles even amid different emphases: providers want data available inside their EHRs with minimal extra clicking; organizations without analytics teams will need technical support and packaged reports; and governance and privacy rules must be clear and transparent to maintain public trust.

No formal action was taken. Fiscal staff will continue to coordinate with AHS and the Green Mountain Care Board on precise budget language and numbers, and the working group scheduled further testimony from technical and program staff to clarify implementation details.

Ending note Stakeholders asked the working group to prioritize early work that improves clinicians’ ability to access relevant clinical information in real time, while the fiscal presentation made clear the Legislature will need to choose how much of AHS’s requested funding to appropriate now and how much to stage into future budgets.