Dartmouth Expert Urges Vermont to Back Primary‑Care Payment Reform, Reinvest Savings
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Summary
Dr. Elliot Fisher told the Senate Health & Welfare Committee that a combination of different payment models, a small innovation fund and strong stakeholder processes could stabilize primary care and yield long‑term health and economic benefits.
Dr. Elliot Fisher, a professor at Dartmouth and a former VA primary‑care physician, urged the Senate Health & Welfare Committee on Feb. 18 to adopt payment reforms that would make primary care broadly available and financially sustainable.
"Pay attention to the social determinants of health," Fisher said, arguing that a mix of investments — more stable payment, team‑based care, workforce expansion and digital tools — would allow practices to coordinate care more effectively and reduce long‑term costs. Fisher described modeling exercises that use 25‑year simulations and suggested that an early, modest innovation fund could catalyze improvements that later lower utilization and raise community GDP.
Fisher pushed back against the rise of concierge and direct primary‑care models that he said can siphon clinicians from general practice. He described an approach in which payers and providers agree on how savings are split and a portion is reinvested in an innovation fund to finance care‑delivery improvements and workforce development. He noted the National Academy of Medicine has recommended similar principles.
Committee members asked about mechanics, timing and the size of the proposed reinvestment. Fisher said simulations show some savings appear quickly if investments target behavior change and care coordination, but he stressed the full benefits are long term and require clear decision processes, public engagement and a committed implementation lead.
The testimony framed S‑197 — described to the committee as a primary‑care payment reform/alternative payment bill — as a bundle of options rather than a single prescriptive model, and the presenter emphasized stakeholder negotiation and safeguards to prevent unintended harms to small practices. The committee did not take final action on S‑197 at this session; members scheduled follow‑up testimony and additional briefings.
