[D]octors, community health centers, and hospitals representing more than 150,000 patients in Vermont have agreed to form a new umbrella organization as a step forward toward creating a regulated monopoly.
The state’s three accountable care organizations — OneCare Vermont LLC, Community Health Accountable Care LLC, and HealthFirst — have agreed to be centrally managed by a new company called Vermont Care Organization.
OneCare includes Vermont’s biggest hospitals and represents about 100,000 patients. The Community Health Accountable Care LLC is largely made up of community health centers, representing about 57,000 patients. HealthFirst is a small group of individual doctors representing 9,000 patients.
Tom Huebner, the chief executive officer of Rutland Regional Medical Center, announced the Vermont Care Organization Tuesday morning. For the past 15 months, he said the organizations have been working under the supervision of the Green Mountain Care Board to decide how they would merge.
But Tuesday’s announcement falls short of a full-on merger among all the organizations. Stakeholders previously thought that all three organizations would join OneCare, change the company’s governance structure, and give the company a new name to reflect the merger.
HealthFirst won’t be a branch under the umbrella organization. The two organizations that had been competing — OneCare and CHAC — will remain legally separate and have several years to decide whether they want to fully merge. But in a sign of collaboration, CHAC has withdrawn a bid it made in partnership with Optum, Inc. to compete with OneCare.
Al Gobeille, the chair of the Green Mountain Care Board, was not available for comment Tuesday.
The Department of Vermont Health Access, which was choosing between bids from OneCare and CHAC before CHAC withdrew its bid, announced Tuesday night it had chosen OneCare to accept payments from Vermont’s Medicaid program. The department framed the decision as a step forward for payment reform.
“We have created an umbrella organization that is intended to coordinate the work of the three ACOs and begin to coordinate the management as well,” Huebner said. “This is all getting ready with the assumption that the all-payer model is going to work out.”
Kevin Kelley, the chair of CHAC’s board of directors, said the organization “could not be more pleased with the progress we’ve made” toward an all-payer model. He said the organization is “confident there’s a shared vision to support community goals.”
The all-payer deal is still under negotiation, according to Gov. Peter Shumlin’s spokesperson. The Shumlin administration and the Green Mountain Care Board have been negotiating terms with the U.S. Centers for Medicare and Medicaid Services for about 18 months.
If the deal comes through, the federal government would issue OneCare monthly payments for Medicare patients of the doctors who belong to the organization. Separately, under the pending contract with the Department of Vermont Health Access, the state would make monthly payments to OneCare for the Medicaid population. Companies like Blue Cross Blue Shield of Vermont would do the same.
Community Health Accountable Care can continue to exist without joining OneCare. Instead of receiving monthly payments for taking care of patients, doctors represented through CHAC can continue to bill for individual services and get incentive payments through the Medicaid program if the doctors avoid higher costs for their patients.
HealthFirst, which represents a handful of doctors, will not operate an accountable care organization under the Vermont Care Organization, according to Amy Cooper, the executive director. A few independent doctors in Vermont will have the opportunity to sit on the board of the Vermont Care Organization. HealthFirst will continue to be an independent nonprofit organization, Cooper said.
“It’s been a very collaborative process over the last 15 months, and HealthFirst appreciates the efforts of all that are involved, and we were pleased to be at the table,” Cooper said.
Huebner said the new management company gives Vermont doctors a choice. They can join OneCare and agree take to reimbursements for keeping patients healthy, or remain in CHAC and continue to receive fee for service payments.
“We think it’s a good start,” he said.
Correction: An earlier version of this story misstated the number of patients HealthFirst represents. The correct number is 9,000. The story was also clarified to reflect HealthFirst’s role under the new model.
