Senate Health & Welfare hears experts urge stakeholder assessment, one‑text approach for S.197 primary care payment reform

Montpelier — The Senate Health & Welfare Committee heard expert testimony on March 10 on S.197, a bill to redesign primary care payment, with witnesses urging a formal stakeholder assessment and a collaborative drafting process before finalizing statutory language.

Chair Senator Jenny Lyons opened the hearing and said the committee wanted “critical testimony” tied to S.197, focusing on how to identify payment processes, where funding would come from and how it should be distributed. She introduced Bob Bordone, described in the hearing as a senior fellow at Harvard Law School, and Dr. Peter Pronovost of University Hospitals in Ohio.

Bordone told the committee that a stakeholder assessment is a structured, evidence‑gathering phase that identifies which parties matter to a negotiation, maps their underlying interests (not just stated positions) and recommends whether a negotiated approach is ripe. "Stakeholder assessment helps map interests," he said, and can show whether a single‑drafter, or “one‑text,” process would be effective.

Explaining the one‑text model, Bordone said a drafting team circulates a single iterative draft to stakeholders, solicits criticism, revises and eventually presents a final text for parties to accept or reject. He said the approach reduces "reactive devaluation" that arises when multiple competing drafts prompt parties to dismiss others’ ideas purely because of the source. Bordone warned that the assessment should identify “spoilers” — parties unwilling to negotiate in good faith — and recommended delaying a one‑text process if essential stakeholders are total spoilers.

Committee members asked practical questions about scale and timing. Bordone estimated a typical assessment with ~30 interviews could be done in a few months and that a subsequent one‑text drafting phase might take another one to two months depending on availability. On whether the bill should enumerate stakeholders, he advised against listing names in statute and recommended allowing assessors to identify credible proxies and relevant constituencies.

Dr. Peter Pronovost framed the problem from a hospital and system transformation perspective, arguing primary care expansion must be paired with clear purpose, frontline engagement and measurable accountability. Pronovost advocated goals such as higher rates of annual wellness visits and routine behavioral‑health screening in primary care, and described an operational model he summarized as “believe, belong, build.” He said his system increased primary care appointments by 14 percent, reduced length of stay by 16 percent and reported large declines in surgical complications and sepsis mortality after implementing the model.

Pronovost cautioned legislators against prescribing detailed clinical practice in law: "The legislation is too slow and too blunt for evidence‑based medicine," he said, and recommended using public reporting, payment incentives and measurable targets so practice can evolve with new evidence.

Both witnesses told the committee that the legislature and executive branch should be involved in any assessment process as stakeholders, but that participants must engage with a mindset of problem‑solving rather than adversarial partisanship. Lyons said staff would consider language in S.197 to allow for a process like the ones described, while noting limited budget resources.

The committee did not take formal action on S.197 at the hearing; Lyons called a short recess and said the committee would continue working on the bill and possible process language. Several senators and staff asked the witnesses to submit written testimony and slides for the committee record.

What’s next: Committee staff will review the witnesses’ materials, and members indicated they may craft bill language that authorizes (but does not prescribe) stakeholder assessment and sets measurable accountability targets tied to any funding for primary care.