Physician witness urges support for S197, says capitation could free primary care to treat complex patients

Dr. Fullman, chair of the Vermont steering committee for comprehensive primary healthcare and a family physician at Little Rivers Healthcare, told the committee that shifting more spending into primary care could improve outcomes and lower overall costs.

“Data shows that patients with a primary care provider have better health and lower health care costs,” Dr. Fullman said, adding that “one study shows that for every dollar spent in primary care, $13 is saved in overall health care spending.” She urged support for the payment reforms outlined in a bill the committee discussed, referenced as S197.

The witness described S197 as a move toward a per-member-per-month payment to primary care practices that would give clinicians "breathing room" to see the sickest patients, expand team-based services and finance care delivered in nontraditional settings such as school clinics and mobile vans. She said the model could allow practices to hire on-site counselors, dental care and care coordinators to help patients with transportation, insurance and social needs.

Dr. Fullman emphasized the practical limits of the current fee-for-service system. “Primary care providers spend 50% of their time on administrative tasks. This is shocking, sad, and unfortunately accurate,” she said, arguing that simplified billing under a capitated or risk‑adjusted system would let clinicians spend more time with patients.

She illustrated the scope of modern primary care with a patient anecdote: during one brief visit her practice addressed diabetes, cardiology follow‑up, mental health, a quick neurologic and gastrointestinal evaluation and even helped the patient by cutting his toenails because he could not reach podiatry. “That is primary care at its best,” she said.

Committee members pressed for details about implementation and risks. Several members warned that a fixed capitation rate could create incentives to avoid complex patients unless the capitation included appropriate risk adjustments. Dr. Fullman said panel size and payments should reflect patient complexity; she cited a broad-family-medicine panel often described around 1,200 patients but said corrective multipliers for age, socioeconomic status and complexity are standard ways to address equity.

Members asked about operational experience. Dr. Fullman pointed to existing Blueprint payments administered through the Agency of Human Services (AHS) as partial precedents but said federal policy uncertainty and varied provider technology make statewide rollout complex. She also referenced a Massachusetts proposal, "PC for You," as a model that uses multipliers to incentivize a broad scope of services in capitation.

Questions also covered behavioral health integration, ownership of primary care by large medical centers, consumer expectations and billing dynamics. On behavioral health, Dr. Fullman said the bill could include incentives for practices to provide mental health and substance‑use services or to coordinate with designated agencies. On ownership, she said safeguards can be written to ensure capitated funds are used to expand primary care even within larger systems.

Committee members discussed reducing quality‑measurement burden so measures align with the payment system rather than producing excessive administrative work. Dr. Fullman said some sites were collecting dozens or hundreds of data points and recommended simpler metrics focused on primary care attachment and basic preventive screens.

The witness flagged a gap in S197 for uninsured patients: if primary care payments are pooled by payer and distributed via capitation, practices may lack a clear funding source for patients with no insurance unless the bill or complementary policy fills that gap. She also warned workforce shortages remain a constraint but argued that a better‑designed system could help recruitment and retention by reducing administrative burden and supporting team‑based care.

The session ended with committee members thanking Dr. Fullman and asking for follow‑up education and materials from the steering committee. No formal vote or motion occurred during the education session.