 Good afternoon, everyone, and welcome to the Green Mountain Care Board meeting. My name is Kevin Mullen, and I'm the chair of the board. The first item on the agenda for this afternoon will be the executive director's report. Susan Barrett. Thank you, Mr. Chair. I have a few announcements. First, I just wanted to make sure the board knew, as well as the public, that our council today is Associate General Counsel of the Green Mountain Care Board, Lynn Combs. So I wanted to make folks aware of that. I also have a rate announcement to make on June 16 of this year, 2020, the board issued its unanimous decision in the signal large group rate filing signal requested rate changes that would have an overall impact to the current annual rates of 15%. The board reduced the proposed pharmacy trend adjustment from 6.8% to 6.1%. The proposed administrative expenses from 6.3% to 5.3% and the proposed profit assumptions from 3.5% to 0%. As a result, the board approved an overall impact to the current manual rates of approximately 9%. I also wanted to give an update on a discussion that the board had a few board meetings ago regarding the technical advisory group on pharmaceutical purchasing and prices and the impact of pharmaceuticals on healthcare costs. After that discussion, the board decided that we would move forward with a technical advisory group. The timing on that will be pushed out later to this fall, depending on how we are doing in terms of resources and in light of additional changes that may occur regarding COVID. The last item I wanted to share is that we had no public comments for either of the matters that are proposed for votes today regarding the vital budget and the ACO budget guidance for 2021. And that is all I have to report. I'll turn it back to you, Mr. Chair. Thank you, Susan. In a minute, I'm going to call back on you to take the attendance on the phone numbers. But before we do that, I want to take up the minutes of Wednesday, June 3rd. Is there a motion? Second. It's been moved by member Holmes and seconded by member Pelham to approve the minutes of Wednesday, June 3rd without any additions, deletions, or corrections. Is there any discussion? Hearing none, all those in favor signify by saying aye. Aye. Any opposed? Okay, Susan, I'm going to take it and send it back over to you for attendance. Sure, and I'll be calling out the last four numbers of your phone number if you could announce your name when I call those numbers. I'll start with 2505. I'm going to call it CVM Medical Center. Great, thank you. 0043. Thank you. I'm going to ask you a DRM. 5001. Julia Shaw with the healthcare advocate. Thank you, Julia. 1042. Robin Albus in M.C. Thank you. 0229. Great, Julie. Health first. Thank you. Welcome. 0154. Welcome to Glass Murphy Health Network. Great. 7111. Judy Fox from Rutland. Great, thank you, Julie. I think 19070 is our office. 3212. Kathy Mahoney from the General Advisory Committee. Great, thanks, Kathy. I have also just listed under non-staff Susan Aronoff, Austin Carmon Austin, sorry, Beth Anderson, Bob Cherno, Carol Stone, and Dr. Wasserman. And Spencer Wefler as well. Spencer Wefler. Sorry about that, Spencer. Okay, I'll turn it back to you, Mr. Chair. Thank you, Susan. The first item on the agenda, we're going to turn it over to Sarah Kensler. And that is a vote on the vital proposal, Sarah. Thank you. Give me one moment and I will be sharing my screen. It's just taking a second to load. It looks like. Are folks able to see the presentation? I don't see it yet. Not yet. And now we have it, Sarah. And just, I guess, Susan, this is a good time to mention that beginning in July, we will be switching the platform to Teams. Great, yes. We found that the Skype support has trailed off and some technical difficulties have occurred in terms of research. We found that Teams is really the way that Microsoft is going and the state is supporting that. So we'll be moving that July 1st and Abigail will share all of the information for folks moving forward. I'll also mention that the slides Sarah has on our screen are also on our website. Okay, Sarah, whenever you're ready. Excellent. Thank you so much. For the record, this is Sarah Kensler, Director of Strategy and Operations at the Green Mountain Care Board. I'm going to give a very brief overview of the board's oversight authority related to Vermont Information Technology Leaders, or VITAL, Vermont's Designated Soul Health Information Exchange Network. Summarize VITAL's budget submission presented on June 3rd and provide a staff recommendation. I texted you. He should have passed. I put him in the back. If we could just ask everybody to mute themselves so we don't hear the motion of the background. All right, thank you. For the board's oversight and policy-making activities related to health information technology and health information exchange, the board is required to review and approve VITAL's budget annually. This authority came to the board in 2015 and was first exercised in 2016. The board's oversight is intended to provide strategic guidance and policy parameters. VITAL presented its FY 2021 budget to the board on June 3rd. But this slide summarizes VITAL's FY 21 budget submission as a reminder, the board approved VITAL's initial FY20 budget in June 2019. VITAL requested a budget adjustment approved in January 2020 due to increased work scope and revenue from its contract with DEVA. So for fiscal year 2021, VITAL anticipates $1.1 million in revenue. This includes $7.6 million in state funding. As a reminder, VITAL's contracts with the state run on a calendar year basis, so this budget reflects six months of revenue that's already been awarded while the second half of the fiscal year, that's January to June 2021, is an estimate. VITAL's fiscal year 2021 budget includes an increase of $1.1 million in state funding compared to the updated fiscal year 2020 budget, which is the board approved in January again, but also anticipates a $1 million reduction in VITAL's contract and VITAL's calendar year 2020 contract with DEVA due to work expected to be delayed or not performed due to COVID-19. The budget also includes the $1 million in non-state funding and a $517,000 negative revenue item from the anticipated impact from COVID. VITAL has budgeted $7.8 million in expenses. Labor is the largest expense at $3.1 million followed by software and server maintenance and the high hosting. In addition to that $517,000 negative revenue line mentioned earlier, VITAL has also built in an additional $100,000 in contingency expense line. Does the board have any questions about the budget submission itself or shall I move on to the review criteria? I think we can hold everything to the end, Sarah. All right. So when the board first began reviewing VITAL's budget, it established four principles for review. These are listed on the board's website. In the following slides, I'll walk through these criteria along with the staff assessment of whether these criteria were met. First, the review process will be transparent and will incorporate public input. We usually measure that by compliance with the budget guidance and overall transparency of the budget process. And this year we found that VITAL has complied with the budget guidance. The guidance was submitted on May 18th and May 19th as required and included all requested components. VITAL also responded to board members' questions about the budget in a timely fashion and provided additional information when requested. A special public comment period was open from Tuesday, June 2nd through this past Monday, June 15th. And as Susan noted, the board received zero written comments. The second review criteria is that the board will review VITAL's budget in order to determine whether it reflects the strategy and priorities consistent with the state's healthcare reform goals and the health information technology plan. The board will not direct the technical details of VITAL's work or the details of VITAL's contractual relationship with the state. So staff assessed alignment relative to the goals of the 2019 to 2020 HIE strategic plan, which was approved in November and updated in January and is also available on our website. Staff found that VITAL's budgeted activities will advance the goals of the HIE plan, which I've listed here, by pushing toward more effective foundational services, exchange services, and end-user services. And these are categories which reflect the Office of the National Coordinators framework for describing critical health information exchange services, which is the framework that our HIE plan relies on. And I've also included some examples of the projects, which I think support these different kinds of services. Third, the board's review process must be structured in time in order to assist DEVA and VITAL in negotiating timely and effective agreements each year. I'll note that this criteria was more critical than VITAL's budget year and its contract year with DEVA had the same start date, but now that they're staggered, this is less critical. That said, GMCB staff worked closely with DEVA staff to ensure that this review timeline wouldn't step on their toes at all or with their federal contracting requirements. And lastly, the process must result in board decisions that are sufficiently clear to enable VITAL to do its work and DEVA to support that work without requiring repeated clarification or intervention by the board. Staff will ensure that written decision stemming from this budget review is sufficiently clear. So, given these findings, my recommendation is to approve the VITAL budget as presented with two conditions. First, VITAL and DEVA will return to the board in late 2020 to present their January to June 2021 budget once those contract negotiations with DEVA for their calendar year 2021 budget are, excuse me, contracts are completed. And secondly, VITAL will present to the board quarterly to provide updates since the budget approval, which will include updates on governance and operations, finances, and technology, as well as a copy of their plan for stakeholder outreach to gather feedback on integration of 42 CFR Part II and other sensitive data in the Dehigh, which is an initiative that they are currently working on that we heard about at their budget presentation. I'll just note that VITAL currently reports quarterly to the board on governance, operations, and technology using templates developed by GMCB staff, so this would be a continuation of that reporting. That is all. Does the board have any questions about VITAL's budget or this recommendation? Board members, any questions? I'm not hearing any, but I do think we should open it up to public comment before there's a motion. So at this point, I'll open it up to public comment on the VITAL presentation. Very, very quiet group today. Do I have a motion from a board member? Well, I'll move that we adopt the VITAL budget as presented by staff. I don't have the screening up in front of me, or I would be more specific. Sarah, could you just put that screen back up that shows what your recommendation was? Yes, absolutely. My apologies. I was doing that. I would like to thank her for her hard work. Looking forward, there will be some improvements in the budget process. One of them is getting a measure of these consolidated collaboration savings because VITAL ended up being the deliverer of the products there. Their budget went up on some line items that look significant, but in fact it's a part of an across-the-board savings with the Department of Health and VITAL and DEVA and the Blueprint. I think the next time we see the budget we'll be able to have that as background to the investments in collaborative services. Okay. Member Pelham has moved that the VITAL budget be approved as presented with two conditions as presented by staff. Is there a second to that motion? Second. It's been seconded. Is there discussion from the board? Hearing none, all those in favor of the motion signify by saying aye. Aye. Any opposed, say nay. So that motion is carried. Thank you, Sarah. I think Tom said it well that you did a great job on this year's VITAL presentation and thank you for all that you do. We're going to transition over so, Sarah, if you could take yourself off the screen and we're going to turn the meeting over to Alayna Barabee on the ACL budget guidance. So whenever you are ready, Alayna, take it away. All right. Thank you. I'm going to share. Was that your house where somebody was supposed to be in the bath? Yeah. I was glad you had the first part of that. On that time accident. Anyway, so I'm glad I didn't share more. So we'll dive into the AC home budget. Can you see my screen? Yes. Yes. Okay. Great. So today we're going to revisit the FY 2021 ACO oversight process. So this will be budget guidance and certification, eligibility verification and, you know, if everything looks good to you, then we can contemplate a board vote. Okay. So first I'll summarize kind of what we went over on the third. Very briefly discuss public comment. Some minor edits since the June 3rd presentation and then next steps. So just to reiterate our goals for the 2021 oversight process were really to think about regulatory integration and to think about how we can continue to reduce the administrative burden on our regulated entities, especially in the wake of COVID-19. So these things, you know, need to be balanced certainly. And then, you know, for ACO oversight processes, we don't really have any changes for the certification eligibility forms. That's just more rolling it over year to year. But on the budget guidance, we really thought to simplify questions and reduce redundancies, clarify references either, you know, where the ACO or all care model are distinct. Separate content necessary for budget guidance versus ongoing monitoring relying on data more than narrative. And then understand changes due specifically to COVID-19 versus other factors and then try to understand implications of participation for hospitals. Those are the main criteria that we discussed two weeks ago now. And then just at a high level the framework is organized around the introduction which talks a little bit about, you know, why we have this process and then how we organize this COVID-19 is a major challenge to this year and thinking about next year. And then part one is the reporting requirements organized around these eight categories, background, provider network, payer program, sole cost of care, risk management, the ACO's budget and then all of their programs around quality improvement population health model of care and then how they integrate with their community initiatives. And then some other questions on the model specifically. Part two discusses the ACO budget targets or Medicare benchmark and some other targets and then part three discusses staff plans to put together a monitoring document that will serve as a companion to this document here. Public comments, we have no public comments that were submitted and that was true I think even until this morning. So we haven't seen anything come in but I did, we did take into consideration all the board comments that were made during our last presentation incorporated those and then we're also working with one of our contractors on a bigger initiative to look at system-wide risk and they have provided some guidance to our hospital budget process which got postponed to later in the summer or the early fall but we want to make sure that they're aligned. So we had them review our guidance in the meantime and they offered some feedback to help us kind of clarify how the funds flow between these processes. So in section two, it's minor but we really wanted to differentiate between the different types of payment types so some of these fixed payments are risk-based and some of them are more cash flow mechanisms so being clear about what we mean by FTP and when it's or spacing lens not. Section five, we want to differentiate between risk transfer to our providers and risk mitigation and that helps alleviate some of the burden of the risk on our providers and then this is going to be the whole. Section six, so this is where I'm going to ask for a little flexibility over the next week or so but we would like to reorganize the hospital participation. It does slide but it should say appendix to better align the hospital budget process so we'd like to disaggregate there's a line in there that says reserve adjustments and hiring your reconciliation so we kind of want to dig into that a little more and separate it by program and fiscal year and then understand when it's about reconciliation to fee for service so those fixed payments are really about performance settlement so we are thinking about quarterly financials but we think that we would like some time to kind of dig into this little further still hitting our July 1st deadline but the spirit of that exercise will remain and it will align between the ACO and the hospital budget process and in addition we think it's imperative that we add a glossary of key terms so we've started compiling that and with another week or so to finish that but that would just be to provide some definitions and clarity to the guidance. In terms of next steps though today this might language for the motion might look a little different than what you saw earlier Lynn thank you for your help with this but this is the proposed motion to vote on the guidance that will allow us the flexibility to kind of finalize the glossary finalize appendix 6.6 which is the detail of hospital participation and then kind of adjusting the formatting if necessary which I think we're pretty much there anyway and then the next date would be July 1 to issue the guidance and the certification eligibility verification form and then September 1 we would expect one care to submit the certification form in October 1 for one care to submit their budget and that is what I have for you today please let me know if you have any questions and I'd be happy to answer them okay questions from the board very quiet group today it must be that beautiful weather at this point I'm going to turn it over to public comment is there any public comment hearing none is there a motion by a member of the board I'm happy to make the motion this is Robin I moved to approve the 2021 ACO budget guidance and allow staff to finalize the glossary and appendix 6.6 relating to hospital budget participation excuse me hospital participation in the ACO consistent with our discussion today and just formatting to other appendices as needed I'll second so it's been moved and seconded is there further board discussion if not all those in favor of the motion signify by saying aye aye any opposed the motion is approved thank you Elena another very good presentation thank you all for all your help over the line is there any old business to come before the board