S197 would create statewide primary care payment pool, aim for 15% of spending on primary care

Jennifer Carvey presented S197, a bill to establish a primary care payment reform program intended to shift more health‑care dollars into primary care without increasing total system spending.

Carvey said the program would be administered by the Department of Vermont Health Access, operating a payment pool that aggregates participating payer funds (commercial premiums, premium equivalents from other payers) and distributes risk‑adjusted per‑member‑per‑month payments to participating primary care practices. Participation would be voluntary at first with an implementation schedule that moves toward universal participation: operations by 07/01/2027 and broader participation by 01/01/2028.

The bill includes guardrails: use of risk adjustment to reflect patient mix, limits to prevent adverse selection or cherry‑picking, attempts to minimize administrative burden and limits on how quality measures can be applied. Carvey said the bill directs negotiation with federal officials to seek Medicare participation and outreach to self‑funded employer plans for voluntary inclusion.

S197 sets an explicit target: the department should increase the proportion of total annual health care spending devoted to primary care to 15% by 01/01/2029 while holding total health spending steady. Committee members requested prior reports and comparisons with other states; counsel offered to provide an earlier Vermont clinician landscape report and related materials.

Carvey noted the bill also directs reports on clinician workforce issues, site neutral reimbursement, and regional collaboration on a potential universal primary care program with neighboring states; it would remove the sunset on an existing loan repayment/scholarship for clinicians who commit to primary care work in Vermont.