Lawmakers, regulators debate how to strengthen primary care without weakening hospitals

At a joint meeting of the Vermont Senate Health and Welfare and House Healthcare committees, lawmakers and regulators discussed how to expand community-based primary care while keeping hospitals financially sustainable after presentations from the Milbank Foundation and Dartmouth researcher Elliot Fisher.

Committee members said the state’s long-standing Blueprint for Health and payment reforms such as all-payer and ACO-based population payments could support primary care delivery — if the state can trace and, when needed, condition how funds flow from payers through hospitals and provider systems to the clinicians who deliver care.

Why it matters: Primary care is central to cost, access and quality. Committee members and presenters warned that without clearer accountability for where primary care dollars end up, policy changes intended to shift care into the community may fail to produce the promised improvements in access or…