Lawmakers, state agencies and advocates debate Section 10 of S.126 to create unified health data space

Section 10 of Senate Bill 126 would add a new section to Title 18 directing the Agency of Human Services to collaborate with the Health Information Exchange Steering Committee to develop an integrated system of clinical and claims data intended to improve patient, provider and payer access to information and reduce administrative burdens.

The provision would require insurers, under a broad statutory definition, to provide clinical and claims data to the Agency of Human Services as directed by the agency, and would require AHS to provide an annual update on progress to the relevant legislative committees on or before Jan. 15 each year.

The discussion on April 23 centered on trade-offs between potential benefits — better population health analytics, fewer duplicate tests and improved care coordination — and the technical, legal and cost challenges of linking multiple datasets while protecting patient privacy.

Will Dempsey, Health Data Officer for the Vermont Agency of Human Services, told the committee that AHS is building on existing work and expects the Medicaid Data Warehouse and Analytics Solution (MDWAS) to go live by the end of the calendar year. He said the MDWAS will link Medicaid clinical and claims data for Medicaid members and called patient privacy “our first and foremost priority.”

Dempsey said AHS supports involvement of the Health Information Exchange (HIE) Steering Committee and described the committee’s cross-sector membership, including the Agency of Human Services, Department of Vermont Health Access, Vermont Department of Health, the Office of the Health Care Advocate, Bi-State Primary Care Association, Blue Cross Blue Shield of Vermont, Vermont Healthcare Association, Vermont Association of Hospitals and Health Systems, Vermont Care Partners, a consumer representative, the Agency of Digital Services, Blueprint for Health and the Green Mountain Care Board.

Lindsay Kille, deputy director of data and analytics for the Green Mountain Care Board, said the board supports the goals of a unified health data space but emphasized the need to avoid duplicating existing systems and to keep patient privacy and security central. "The GMCB is supportive of the Unified Health Data Space goals," Kille said, and described current uses of claims and clinical data for the state health delivery plan and all-payer model analytics.

Sam Pyshfield, the state Health Care Advocate, and Eric Scholtes, staff attorney for the Office of the Health Care Advocate, said they have worked toward consensus language that would place privacy, safety and measured evaluation at the center of any integration effort. Scholtes told the committee, "we don't honestly know if claims data can be used for clinical purposes," and said the planned Medicaid pilot will help test that question.

Beth Anderson, president and CEO of VITAl (the operator of the Vermont Health Information Exchange), described the HIE’s current role providing near-real-time clinical information to providers and urged caution about reuse of those data. Anderson said the HIE limits some downstream uses of clinical data to protect patients and encourage provider participation. "We are the operators of Vermont Health Information Exchange," Anderson said.

Committee members asked repeated questions about cost, timing, opt-in vs. opt-out consent, who would analyze linked data, whether the system would deliver real-time patient records for clinicians, and how smaller hospitals and clinics could use any new analytics or portals. Dempsey estimated implementation of an initial integrated system would take 18 to 24 months, and he said AHS was not currently seeking additional funding tied explicitly to Section 10. Witnesses cautioned that a truly real-time, statewide integrated claims and clinical feed comparable to New York’s system would be more expensive than Vermont’s current contracts.

Multiple witnesses noted existing state resources that would feed or inform an integrated system: the Medicaid Data Warehouse and Analytics Solution (MDWAS), the Vermont Health Information Exchange (VITAl), the Green Mountain Care Board’s claims systems (the all‑payer claims database/VCURES and related hospital discharge data) and Blueprint for Health analytics. Several presenters said the work should reuse existing infrastructure where possible rather than creating new parallel systems.

No formal vote or adoption of Section 10 language occurred during the hearing. Multiple parties said they were close to consensus language and expected to circulate revised statutory text and a memo to the committee later in the week for additional review.

The committee members asked AHS and the named agencies to return with clarified language that specifies permitted uses, measurable cost or savings reporting, and a clearer plan for provider-facing tools, training and phased implementation. AHS and partner agencies said they would supply updated draft language and a memo describing proposed measurements and timelines.

The hearing record shows the continuing debate is about whether an integrated clinical-claims data system can be built to deliver both actionable clinical information at the point of care and policy-level analytics without violating privacy norms or imposing prohibitive costs. The witnesses agreed on the need for pilot testing, clear limits on permissible uses, and layered governance through the HIE Steering Committee and existing statutory plans.