by Hamilton E. Davis
Andy Pallito, the top numbers guy at the Green Mountain Care Board, is leaving the Board after just nine months on the job. Pallito will take a finance position at the Community College of Vermont. He will leave the GMCB in mid-March.
Pallito will become Dean of Administration for the 12-campus unit of CCV, which operates under the umbrella of the Vermont State Colleges. “It was a fantastic opportunity that I just could not pass up,” Pallito said. “And it will round off 26 years of service in Vermont state government.”
The loss of Pallito, coming as it does in the formative days of the Fiscal Year 2019 hospital budget season, is a serious blow to the Board. The budget process is particularly complex this year because the Board has to integrate its normal regulation of spending for the State’s 14 hospitals with the first full year of OneCare Vermont’s program to shift the financing of health care from fee-for-service to capitation.
OneCare Vermont, the state’s only Accountable Care Organization, will function as a consortium of doctors and nine of the 14 hospitals that will offer care to roughly 20 percent of the state’s population under fixed price contracts with the State’s Medicaid agency, federal Medicare officials, and Vermont Blue Cross.
The most important of those contracts is the one with Centers for Medicare and Medicaid Services, which administers the federal Medicare program. Beginning this year and extending out five years, Vermont’s health care delivery system is committed to hitting cost containment targets that are lower than federal Medicare trends across the country. The key element in that equation is spending by Vermont’s hospitals.
Pallito’s first year covered just the latter portion of the budget year, which begins now with guidance from the Board to hospitals that are drafting their spending plans. Those plans must be submitted to the Board by July 1; and the Board has to announce its final authorizations by Oct. 1.
Kevin Mullin, the chair of the Green Mountain Care Board, will have to scramble to find a replacement. And there are some indications that it won’t be easy. The decision by Governor Phil Scott to cut three members of the Board’s 28-member staff, and Mullin’s routine acquiescence in it have generated a serious morale problem at the Board. I wrote about that in my last post. (L-link). Mullin has to hope that Pallito is the last shoe to drop, not the first.