Green Mountain Care Board members on Wednesday approved the budget for Vermont’s only active “all-payer” responsible care organization, but reduced its administrative component by 2%. That comes out to just over $300,000, bringing the total down to $14.9 million.
For some members, the cut was clearly a way to show their dissatisfaction with OneCare Vermont’s apparent lack of progress in achieving tangible results. Accountable Care Organization, or ACO, plays a key role in Vermont’s current health care reform strategy.
“I think Vermonters are looking at whether or not we get a return on what we’re working for,” said board president Owen Foster. Considering all the information presented, “I do not find that fiscal responsibility has been achieved, and I do not find that this budget as presented has been fully justified,” he said.
To others, the cut was more of an acknowledgment that the ACO’s budget would soon have to be revised downward anyway, as the state’s largest health insurer announced Tuesday that will not enroll members with OneCare in 2023.
“Could you support a modest reduction in operating expenses?” asked Jessica Holmes, a board member since 2016. “Yes, probably, but in large part because I believe … that there will be a reduction in administrative costs associated with the retirement of Blue Cross Blue Shield.”
Accountable Care Organizations are private groups of affiliated health care providers who contract with private insurers and the federal or state government to provide care to a specific group of patients. Blue Cross and Blue Shield of Vermont was the largest private insurer to participate, giving OneCare approximately one-third of its business.
The board asked OneCare to submit a revised budget to reflect that change by the end of next month. The budget approval also required OneCare to provide a ROI analysis of the money spent on the effort between 2018 and 2022, and submit a report comparing its performance to other ACOs.
The board also specified that OneCare should begin using its own reserves to support the $9.5 million that Medicare will provide through the ACO to several of the state’s priority health programs in 2023. If OneCare hospitals and providers, as a group, exceed their Medicare spending threshold by more than 3%, those funds would be returned to the federal government. In the past, the organization’s provider network was entirely responsible for returning these funds, although a return has not yet been required.
While the budget passed unanimously, the cuts passed in a 4-1 vote, with Robin Lunge, a board member since 2014, in opposition.
Lunge said that while he agrees that changes need to be made to some of OneCare’s processes, those improvements are already underway. In addition, the organization’s challenges need to be viewed in the context of the global Covid-19 pandemic and current “workforce challenges and other pandemic-related aftershocks,” he said.
“I cannot stress enough, myself, how the pandemic has disrupted this program,” Lunge said. “I am not ready, at this moment, to say that there has been fiscal irresponsibility, and that is why I cannot support a 2% cut,” although she said she also expects a reduction in the operating budget if Azul Cross does not really have a contract with OneCare by 2023.
When asked at his weekly news conference Tuesday about the insurer’s departure, Gov. Phil Scott said the administration planned to become involved in negotiations between Blue Cross and OneCare.
“We think it’s important that Blue Cross Blue Shield and OneCare come together here, and we’ll move forward to encourage that,” Scott said.
State employees are insured by Blue Cross, and beginning in 2021, those who do not opt out are enrolled in OneCare through that contract, even though the state employees union opposed in the idea in 2019.
Dave Bellini, a retired state employee and former president of the Vermont State Employees Association, thanked Green Mountain Care Board members in public comment Wednesday.
“You’re all asking the hard questions and I think it’s a new day,” Bellini said, adding that he represents an “ordinary Vermonter.”
“I can give you the perspective of someone who was in the hospital this morning, someone who has an elderly parent,” Bellini said. “I don’t know what the OneCare metrics are. I mean, it’s hard to understand what they do, other than some monstrous process that they’re proud of.”
But “if you can’t see it on the ground, if Vermonters aren’t experiencing better health care, better access, lower costs, I don’t think it’s working,” Bellini said. “There is an old expression: ‘the dog does not hunt’. So I’ll leave it at that.”
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