Act 113 of 2024 (Sec. E.345.2) tasked the Green Mountain Care Board to contract with a qualified entity for a reference-based pricing analysis that will analyze commercial medical claims for all inpatient and outpatient hospital services and supplies incurred by active and retired members and their dependents enrolled in the State Employees’ Health Benefit Plan and in the health benefit plans offered by the Vermont Education Health Initiative during calendar years 2018 to the most recent year for which data are available, to determine what savings, if any, could have been realized for that period if a reference-based pricing methodology benchmarked to Medicare rates had been applied.
Health Management Associates (HMA) was contracted to perform the data analysis.
Additionally, GMCB was asked to submit a report to the House Committees on Health Care and on Government Operations and Military Affairs and the Senate Committees on Health and Welfare and on Government Operations on or before December 15, 2024.
- GMCB Reference-Based Pricing Final Report (12/16/2024)
- HMA Reference-Based Pricing Analysis (12/16/2024)
Reference-Based Pricing Resources
American Hospital Association (AHA) Fact Sheet: What Is Reference-Based Pricing?
GMCB Roundtable Discussion regarding Reference-Based Pricing (May 3, 2024)
- GMCB YouTube recordings: part 1, part 2, part 3
- Meeting presentation slides