by Morgan True vtdigger.org Anya Rader Wallack, the former chair of the Green Mountain Care Board, may accept a consulting job with Dartmouth-Hitchcock Medical Center to work on multistate payment reforms in northern New England.
“(Dartmouth-Hitchcock) is looking at potential models for health care payment and delivery cost containment and population health management across Maine, New Hampshire and Vermont,” Wallack said Tuesday.
Though she has not signed a contract with the health system, Wallack felt it was necessary to make public that she is in talks with Dartmouth-Hitchcock.
Anya Rader Wallack
“At this point it’s just been discussions,” Wallack said in an interview Tuesday. “But given my role on the SIM grant core team I felt I needed to reveal and disclose that.”
Wallack manages a $45 million federal State Innovation Model grant that was awarded to Vermont last year to help the state change health care payment and delivery models. She has a $100,000 consulting contract with the state.
In her role as chair of the SIM grant core team, Wallack contributed to a set of recommendations for the design of Vermont’s new shared-savings program offered to Accountable Care Organizations (ACOs).
OneCare Vermont is the largest ACO in the state and is co-owned by Dartmouth-Hitchcock Medical Center and Fletcher Allen Health Care, although its membership includes all Vermont’s hospitals.
Its executives and managers are pulled from both hospitals, but they’re not paid for work they do for OneCare, according to Mike Noble, a spokesman for Fletcher Allen.
Both hospital systems stand to benefit financially if OneCare’s members realize shared savings through the program Wallack helped design.
Dartmouth-Hitchcock and Fletcher Allen are covering OneCare’s initial costs, but if it generates a profit through the shared-savings programs, 10 percent will go to OneCare to cover administrative costs, Noble said.
The other 90 percent will be distributed to OneCare’s members – including Dartmouth-Hitchcock – according to a formula that was not immediately available.
“If OneCare Vermont receives any revenues in excess of expenses from participating in the shared-savings program, those revenues must be used to further Fletcher Allen’s and Dartmouth-Hitchcock’s tax-exempt missions,” according to a statement from OneCare.
Wallack said her role in helping design the shared-savings program OneCare participates in with the state’s Medicaid program and private insurers would not create a conflict of interest if she were to consult for Dartmouth-Hitchcock on other payment reform initiatives.
“I don’t think anything I’ve done in the past has had any clear advantage for Dartmouth-Hitchcock,” Wallack said.
“I don’t think I’ve had any conflict in the past, and I’ve made clear that if I have any conflict in the future I’ll recuse myself,” Wallack added.
In a letter to Secretary of Administration Jeb Spaulding, Wallack wrote that she plans to recuse herself from any discussion or votes on expenditures that “could benefit DHMC directly, or DHMC indirectly” through its membership in ACOs.
Wallack also plans to recuse herself from discussions around policy recommendations to the board or state agencies on “such matters where there might be a real or perceived conflict of interest between my actions as Core Team Chair and my role as a consultant to DHMC,” according to the letter to Spaulding.
Gov. Peter Shumlin said in a statement he does not see any conflict of interest in Wallack’s consulting for Dartmouth-Hitchcock.
“I’m pleased Anya will be working with Dartmouth-Hitchcock to pursue many of the cost savings and quality improvements across Maine and New Hampshire that are already underway here,” Shumlin said. “We will continue to work with Anya through her role as Chair of our SIM grant, and will of course expect the grant committee and participants to handle any potential conflicts that may arise.”
In a statement, a Dartmouth-Hitchcock spokesman said, the hospital system is “in discussions with Anya Rader Wallack about a possible role as a consultant as we work to innovate in payment and delivery reform regionally and nationally.”
Another of Dartmouth-Hitchcock’s co-ventures with Fletcher Allen, the Northern New England Accountable Care Collective, recently applied for a $30 million federal grant to innovate payment reforms.
Two health systems in Maine are also founding members.
That grant is still pending, but the money would be used to transition the collective’s members from shared-savings programs to “… a global capitation payment model for Medicare, Medicaid, CHIP, and dually eligible beneficiaries, employees and dependents of our health systems, and ultimately to participating commercial payer populations,” according to the grant application.
A global capitation payment model, often called a global budget, is essentially the sum of all payments made to a hospital or hospital system from all payers over a given period, typically the previous year, adjusted for inflation and demographic changes in the patient population.
If a hospital or hospital system goes over budget, it receives no additional money. Health systems have shown interest in the model because it guarantees revenue in an uncertain and rapidly changing industry.
Wallack is a logical choice to help the multistate coalition of health systems to innovate payment models, given her strong health policy background and regional knowledge.
She has consulted for multistate provider groups and state governments for nearly a decade, according to the bio on her consulting firm’s website.
“It’s certainly related,” Wallack said of the work she’s doing for Vermont and the role she’s discussed with Dartmouth-Hitchcock. “It’s all part of general thrust that is moving provider payment away from fee-for-service, different client, different job … the subject matter is similar.”