Sen. Jenny Lions outlines bill to align primary-care payments, increase transparency

Sen. Jenny Lions, sponsor of bill 197, told the Senate Health Committee that the proposal aims to align payments across payers, reduce administrative burden, and expand access to primary care by making payment models more uniform and transparent.

The bill builds on the primary care advisory committee and Act 68 and would encourage the use of indices (Sen. Lions cited the Medicare Economic Index and resource-based relative value scales) and risk-adjusted payment approaches so funding is “uniform and aligned,” she said. She also said the bill would open payer-provider contracts to increase transparency and support a payment system inclusive of Blueprint practices, independent practices, and community-based providers such as social workers and nutritionists.

“Alignment of payment is critical,” Sen. Lions said, adding that better, aligned payments would reduce administrative burden and help sustain primary-care practices. Asked about return on investment, she noted commonly cited figures: “Some people say $13, but the new number is $18,” referring to dollars saved later in care for every dollar invested in primary care.

Committee members pressed Sen. Lions on likely impacts and implementation. One member raised concerns the changes could harm small hospitals and asked how the bill would secure buy-in from self-funded (employer-sponsored) insurance plans. Sen. Lions said making primary care payments sufficient and attractive — for example, enabling several accessible visits per year with lower cost-sharing — would encourage uptake, but acknowledged the committee cannot directly control employer-sponsored insurance.

Members also questioned why the bill allows a standard other than the NCQA patient-centered medical home; Sen. Lions said the flexibility lets the director of Blueprint identify an alternative quality standard if appropriate. On rate-setting, members debated whether methodology and dollar amounts should be developed by AHS/Blueprint or routed to the Green Mountain Care Board. Sen. Lions favored a collaborative, stepwise approach among AHS, Blueprint, the board and relevant stakeholders, and cautioned that federal Medicaid and Medicare rules and AHS fiscal pressures constrain unilateral moves.

A member asked whether the bill included an appropriation or fiscal note; Sen. Lions said it did not go to finance and had no fiscal note, and she noted provider-stabilization dollars had been discussed on the House side. “Nice to have some funding to do something,” she said, and suggested appropriators could consider analytic costs.

On Section 7, which directs reporting by the Vermont Medical Society, committee member Daisy asked whether the language intends to shift certain post-acute services out of hospitals into community settings. Sen. Lions said the section aims to identify when care delivered in hospitals could safely move to primary care or community providers, but that specialists and providers must be involved to specify which services are appropriate to transition.

The committee did not take formal action on the bill and recessed until 9 a.m. the following morning. Members asked to continue collaboration on payment methodology, data analysis and funding to implement changes.