State officials warn Vermont health system faces fiscal strain; Oliver Wyman report and Act 167 work to guide changes

Jenny Samuelson, secretary of the Vermont Agency of Human Services, Owen Foster, chair of the Green Mountain Care Board, and Emily Brown, deputy commissioner of insurance at the Department of Financial Regulation, told the Healthcare Reform Oversight Committee on Nov. 22 that Vermont’s health system is under sustained financial pressure and that the state is pursuing a mix of payment reforms, hospital transformation work and targeted investments under Act 167.

The officials said insurers and providers have seen a sharp rise in claims and utilization since the COVID-19 low, leaving insurers with monthly losses and hospitals with dwindling reserves that threaten service lines in some communities.

Why it matters: Committee members were shown data and a set of recommendations from the independent Oliver Wyman review commissioned under Act 167. The report and the state’s subsequent work are intended to map options — including the federally negotiated AHEAD model, hospital global budgets and targeted investments in primary care, mental health and long-term care — to sustain hospitals, protect access in rural areas and slow premium growth.

State and regulator overview

Jenny Samuelson, secretary of the Agency of Human Services, said the agency, the Green Mountain Care Board and the Department of Financial Regulation are coordinating on the Act 167 charge, which asked them to evaluate multi‑payer payment models, global hospital budgets and stakeholder engagement. "I'm Jenny Samuelson, the secretary for the Agency of Human Services," she told the committee as the presentation began.

Owen Foster, chair of the Green Mountain Care Board, described a years‑long effort to understand system fragility and the budget pressure facing hospitals. "We have not lost the hospital in Vermont," Foster said, adding that the state has preserved hospital access to date but at growing fiscal cost.

Emily Brown, the Department of Financial Regulation deputy commissioner who oversees solvency work, said Blue Cross Blue…