Senate Health & Welfare hears expert on building a statewide health data utility to support primary care and hospital budget reform

Andrea, a member of the Senate Health & Welfare Committee, opened the Feb. 27 session by introducing Craig, a consultant and former director of the Vermont Blueprint for Health, to continue testimony the committee had not finished earlier in the week.

Craig told the committee that states that have succeeded in statewide data aggregation treat the work as a program — a “data utility” — rather than purely a technology project, and that governance, financing and useful products for participating providers and payers are as important as technical capability. “Data moves at the speed of trust,” he said, arguing that sustained participation requires meaningful input from payers, providers and consumer representatives.

The consultant outlined several concrete elements he said guiding legislation or committee direction should address: require regular payer attribution rosters so practices and payers agree on who is responsible for each patient; make near–real-time claims feeds and clinical data available to build a longitudinal health record; permit linkage of identified data in protected environments; set a timeline for having aggregation capabilities in place; and create a formal leadership or advisory council that keeps the program accountable and responsive to users.

The testimony stressed why combining claims and clinical data matters for operations and measurement. Craig noted that while claims payment adjudication can lag six to nine months, most claims event data arrive near real time and — when combined with clinical labs and vitals — produce the most complete longitudinal record for measurement and care management. He also said payer sociodemographic data and regular updates to attribution rosters are critical for risk stratification and for sending capitated payments to the correct practices.

On financing and sustainability, Craig advised that start-up costs are high but ongoing maintenance and interface work are often costlier than states expect, arguing for a transition path from initial state funding to multi‑payer support over time. He urged the committee to require regular public monitoring — for example one‑page dashboards that practices and care managers will actually use — to demonstrate value and avoid participant fatigue.

Turning to payment and delivery reform, Craig described the three-part advanced primary care payment model he recommended: predictable upfront capitated payments to practices, a modest visit-based payment where appropriate, and performance incentives tied to standardized measures (access, quality, and population health outcomes). He said a data‑aggregation platform is necessary to attribute patients accurately, measure outcomes and monitor whether increased primary care investment reaches the “ground game” — staff and services in individual practices.

Committee members raised hospital budgets and reference‑based pricing. Craig recommended tighter coordination between the Agency of Human Services (AHS) and the Green Mountain Care Board and suggested the board could set hospital budget benchmarks tied to a reference (he used Medicare reimbursement rates as an example) while working with AHS on transformation plans for individual hospitals. He said national comparative data indicate Vermont has higher administrative and management costs at hospitals than many peers and that cost opportunities exist without cutting core patient services.

Committee members and Craig also discussed medication and prescription monitoring as a possible use case — for example, reports showing “potential treatment days” derived from pharmacy fills, or identifying patients with potentially risky polypharmacy — and said including pharmacists and pharmacies as stakeholders would strengthen medication‑management work.

The meeting ended with the committee thanking the witness and pausing for a short break before the next presenter. No formal votes or committee directives were recorded in the transcript excerpt.

Ending: The discussion centered on a consistent theme: to make primary‑care investment and hospital budget reform meaningful, Vermont needs a durable, well‑governed data‑aggregation capability, reliable financing, clear leadership roles between AHS and the Green Mountain Care Board, and specific, monitorable products that providers and payers will use.