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Committee reviews S.197 to raise primary‑care payments through Blueprint and set spending targets
Summary
S.197 would require insurers to contribute to higher per‑person primary‑care payments, direct the Agency of Human Services to set spending targets and use the Blueprint to distribute funds; providers warned current Blueprint PMPMs are inadequate.
Lawmakers reviewed S.197 on April 1, a Senate bill that would impose new reporting requirements on insurers, expand the Blueprint for Health’s role in distributing per‑member primary‑care payments, and require the Agency of Human Services to set primary‑care spending targets and a transitional schedule.
Jen KBY of the Office of Legislative Counsel summarized the bill’s main elements: health insurers must submit data to the Agency of Human Services quarterly; Blueprint PMPM payments to participating practices should be based on NCQA medical‑home scores and must be at least equal to Medicaid amounts beginning in 2027; and AHS must publish baseline PMPM spending and proposed target increases with reports due in January 2027 and January 2028.
Practice leaders told the committee the Blueprint methodology and prospective payments can enable practices to provide care coordination, onsite behavioral health and flexible access that the fee‑for‑service system underfunds. Rick Douly, a physician assistant and clinical network director for Health First, described Thomas Chittenden Health Center’s experience with earlier prospective payment models and said the Blueprint’s attribution approach is sound but the PMPM and community‑health‑team payments have been effectively flat since about 2015.
"The per member per month payments have essentially been unchanged since 2015," Douly said, and urged the committee to consider substantially higher PMPM levels. Several witnesses offered ranges: historical blended payments and Blueprint sums were characterized as low‑to‑mid‑double digits per patient, while practice leaders said adequate funding for comprehensive services could be in the order of roughly $100–$125 per patient per month depending on panel mix and services.
S.197 also directs the Blueprint director and related committees to report by January 1, 2027 with an operational plan to transition PMPM payments to cover routine primary‑care needs, define services included in a PMPM, recommend risk‑adjustment and attribution methods, and ensure timely payments from plans. The bill contains language to allow payer‑specific adjustments (for age or health status) and contemplates mechanisms to avoid duplication where private plans provide overlapping coverage.
Pediatricians and primary‑care clinicians said PMPM stability matters for hiring and retaining care coordinators, mental‑health counselors and other staff. They also noted administrative burdens — NCQA certification and quality reporting — consume clinician and staff time and subtract from direct patient care.
No formal vote occurred; staff and witnesses said the bill would require follow‑up fiscal analyses and operational work to set specific PMPM targets and to reconcile implications for insurers, Medicare/Medicaid beneficiaries and self‑insured employers.
