Editor’s note: This op-ed is by J. Churchill Hindes, the vice president for Accountable Care at Fletcher Allen Health Care/Vermont Managed Care.
Wendell Potter’s piece in your opinion section poses a question that deserves informed public dialogue: Are we seeing a shift in Vermont’s health care system?
But he poses it in terms of whether our system, which has long been predominantly nonprofit, is shifting to a “for-profit” model of care.
The answer, emphatically, is no. Across the nation, we Vermonters are viewed – and envied – for our distinctively nonprofit health care system. OneCare will strengthen that, not diminish it.
OneCare Vermont does have the potential to help produce an important shift in Vermont’s health care system, and one that we think is seismic in nature: away from the current fee-for-service payment structure to one that pays based on the quality and outcomes of the services we provide to our patients. That shift, we believe, will promote and support greater collaboration – greater “systemness” – among providers that will, in turn, lead to better care for Vermonters. That’s the kind of change that must happen if health care in Vermont is to get even better than it is, without breaking the bank and without sacrificing the quality of care that is rightfully expected of us.
The ACO regulations require OneCare Vermont’s governing board to be constituted in a way that is not entirely consistent with the requirements of Vermont’s nonprofit corporation law. Federal rules prevail in cases where federal and state rules are out of sync. Simply said, OneCare Vermont did not have the option of being established as a Vermont nonprofit.
OneCare Vermont’s tax status is an artifact of conflicting state and federal rules. The ACO (accountable care organization) regulations require OneCare Vermont’s governing board to be constituted in a way that is not entirely consistent with the requirements of Vermont’s nonprofit corporation law. Federal rules prevail in cases where federal and state rules are out of sync. Simply said, OneCare Vermont did not have the option of being established as a Vermont nonprofit.
I started my health care career in Vermont the same year that Medicare and Medicaid were established – programs that had one of the biggest impacts on health care in the 20th century. I expect to top off my career on the cusp of what I hope will be the next major change, and am pleased to play a role in it.
Should it be successful, OneCare Vermont will capitalize on one of the most attractive opportunities on the health care reform scene to earn higher marks for patient engagement in their care, while fostering excellent clinical practice and “bending the cost curve” – three indisputable needs in Vermont and the nation.
