ST. ALBANS — For Al Gobielle, chair of the Green Mountain Care Board (GMCB), the focus in the press and of public discussion shouldn’t be on single payer health care, but on the efforts around the state to create an integrated, sustainable and less costly health care system.

Gobielle spoke with the Messenger Tuesday afternoon, prior to his appearance in St. Albans this evening at Northwestern Medical Center’s annual scholarship dinner.

“I wish the public knew all of the work that we’re doing,” said Gobielle, referring not to GMCB, but the health care system as a whole.

The health care landscape today is fragmented, explained Gobielle. “You have to defrag it and get it into some kind of system,” he said. “The real role of the GMCB is to really work on this systemness.”

Hospitals, home health care providers, nursing homes, private physicians, and federally qualified health centers have all been working to create an integrated system of care.

He pointed to the work done by Northwestern Medical Center (NMC) and Fletcher Allen Health Care (FAHC) to provide improved care to cardiac patients. NMC’s emergency department now has patients who are in the midst of a heart attack or stroke en route to FAHC within minutes of arrival at NMC.

FAHC physicians also come to NMC to see patients for routine visits at NMC’s cardiac clinic.

Gobielle cited the arrangement as one providing the right care at the right time in the right location. “That’s what saves lives,” he said, adding, “It also saves money.”

For Gobielle, saving money isn’t the primary goal. The primary goal is to improve the health and quality of life of Vermonters.

He offered as an example someone who has fallen and broken his hip. In an ideal system, when the person arrives at the emergency room, his primary care physician would be notified.

Coordination of a visiting nurse to check in with the patient after he leaves the hospital, a physical therapist, and if necessary transportation to follow-up visits, should all be part of the care provided, in Gobielle’s view. Currently, that coordination isn’t automatic and is done with lots of inefficient phone calls.

Chronic illness

The other piece of a health care system is coordinating care for those with chronic illnesses and preventing illnesses such as diabetes and heart disease in others.

“Keeping people healthy is a better business to be in than treating people who are sick,” said Gobielle.

NMC is proposing to expand the health care program it has used to successfully improve the health of its employees to area companies.

Gobielle appeared to support the idea, speaking of the money IBM has saved by supporting wellness among its workers. The company, he said, has saved billions not only in health care costs but also in reduced absenteeism.

But reducing the risk of chronic disease requires primary care physicians who can monitor and work with patients. “Primary care has to be the foundation on which everything else is built,” he said.

Primary care is central to the Blueprints for Health, a statewide effort to reduce costs for those with chronic illnesses. “A small percentage of people use a huge percentage of health care dollars,” said Gobielle.

The blueprint has been shown to reduce the rate of growth in health care costs, commonly referred to as “bending the curve.” With the blueprint patients with chronic illness are all connected to a health care “home” — a primary care physician who takes on the role of coordinating their care.

 Reducing costs

While there are examples of successful efforts around the state to improve the health care system, Vermont still spends $5 billion a year to provide health care for 650,000 people.

Cost containment is key, said Gobielle, but he also wants to assure people that they will not be losing care. “There’s so much information about health reform and then there’s so much misinformation,” he said.

“We’re not talking about reducing the cost of care. We’re talking about reducing the trend,” said Gobielle.

One of the side effects of the high cost of health care has been an impact on wages. Employers are diverting compensation from wages to health care plans, explained Gobielle.

He said that a family insurance plan typically costs an employee $11 per hour. Someone earning $60,000 a year, which is higher than the median wage in Vermont, earns $30 per hour. The employee is spending more than a third of his or her income on health insurance. For employees who earn less, the costs are the same, but it eats up an even larger share of their income.

Vermont’s aging population adds to the challenge of reducing costs. As Vermonters get older, their health care costs increase. At 65, residents can go on Medicare, but that simply changes the calculus, because Medicare pays differently than private insurance, explained Gobielle.

When determining what should be covered in Vermont’s insurance plans, GMCB received 1,800 public comments about dentistry, he said.

With the Affordable Care Act, health insurers are now required to pay for dentistry for children, but Gobielle worries parents may not be aware of the benefits and take advantage of them.

Receiving preventive care when young is one of the best ways to insure long-term oral health, he suggested.

Emergent care

A private New Hampshire company recently announced a plan to open an emergent care facility in St. Albans. Critics have expressed concern the facility will only accept patients with the resources to pay, siphoning those patients from other facilities.

When asked about the facility, Gobielle said the goal is not to need a lot of emergent care, and instead to have people treated by their primary care physician.

There are three large payers in the health care system – Medicaid, Medicare and commercial insurance. “Most people don’t understand that the three large groups of payers pay differently,” said Gobielle. “If your interest is only money, you will only take commercially insured people.”

About Green Mountain Care …

The legislative intent of Green Mountain Care is “to contain costs  and to provide, as a public good, comprehensive, affordable, high-quality, publicly financed health care coverage for all Vermont residents in a seamless manner regardless of income, assets, health status, or availability of other health coverage.  It is the intent of the general  assembly to achieve health care reform through the coordinated efforts of an independent board, state government, and the citizens of  Vermont, with input from health care professionals, businesses, and members of the public.”

— from Act 48 of 2011

‘Keeping people healthy is a better business to be in than treating people who are sick.’

Al Gobielle, GMCB