Health Care

OneCare pushes back on bill that would require open meetings

Photo by Erin Mansfield/VTDigger

Vermont’s largest health care organization is pushing back on a bill in the Senate that would require it to hold open meetings.

The bill, S.4, would require OneCare Vermont, which is set up to become a regulated monopoly representing virtually all doctors in the state, to hold open meetings in most circumstances.

The bill’s language is similar to the Vermont Open Meeting Law. That law requires public bodies, such as selectboards and legislative committees, to hold open meetings, with exceptions such as if the public body needs to discuss contracting or personnel issues.

OneCare is owned jointly by the University of Vermont Medical Center and Dartmouth-Hitchcock Medical Center. The company currently has a $93 million contract with the Department of Vermont Health Access to take care of about 30,000 Medicaid patients for calendar year 2017.

OneCare is in the process of joining with a similar company, Community Health Accountable Care, to morph into the Vermont Care Organization, or VCO. Once formed, the VCO would become the regulated monopoly that would take Medicaid, Medicare and commercial payments and then give that money back to doctors based on the quality of care they provide, not the quantity of procedures performed.

The Green Mountain Care Board, a state regulator that will soon be charged with overseeing the VCO, led a nearly two-year effort to have smaller groups of doctors from community health centers and independent practices merge into the VCO. The agreement was the basis for the all-payer model.

Senate President Pro Tempore Tim Ashe, D/P-Chittenden, is the lead sponsor of S.4 and a known critic of the UVM Medical Center. The other sponsors are Sens. Ginny Lyons, D-Chittenden, and Anthony Pollina, P/D-Washington.

Tim Ashe
Sen. Tim Ashe, D/P-Chittenden County. Photo by Erin Mansfield/VTDigger

“A constituent contacted me and suggested that in light of the importance of ACOs in the State’s health care future we should clarify which of their meetings must be open to the public,” Ashe said in a statement. “The existing law was not very clear and this small bill merely borrows from another section of Vermont law.”

Todd Moore is the chief executive officer of both OneCare and the VCO — and the senior vice president of accountable care and revenue strategy at the UVM Health Network. Moore testified against S.4 in the Senate Health and Welfare Committee on Feb. 3.

“The requirements are tantamount to imposing the Open Meeting Act (and actually offer fewer exceptions than the Act itself), despite the fact that those requirements can only apply to public bodies, and the ACOs don’t qualify as public bodies,” he wrote. “In fact, ACOs are private organizations with voluntary contracts with state and federal governments, not quasi-public.”

The Senate Health and Welfare Committee scheduled additional testimony for Feb. 22, and then canceled it. Sen. Claire Ayer, D-Addison, the committee chair, said that day that OneCare’s lawyers were working with the Legislature’s lawyers to come up with a compromise.

Claire Ayer
Sen. Claire Ayer, D-Addison. Photo by Erin Mansfield/VTDigger

“They’re thinking maybe it shouldn’t apply to them — that we don’t have any business telling them what to do — and our lawyers are talking to their lawyers,” Ayer said. They decided they couldn’t take testimony  until these issues are resolved, she said.

Moore said in an interview Monday that he supports having OneCare be transparent. But he said the board needs to have difficult discussions to make decisions, and the meetings can’t be open in all circumstances.

“The ability for the board to discuss multiple options in a way where they need to make a decision — that discussion happens best, and you get everybody’s best thoughts on the table when it’s a private discussion,” he said.

Moore also pointed to Act 113, the law the Legislature passed in 2016 to regulate ACOs. That law says the ACO’s board meetings must “include a public session at which all business that is not confidential or proprietary is conducted and members of the public are provided an opportunity to comment.”

Moore said that law also requires transparency on issues such as the ACO’s budget because OneCare will have to get certified through the Green Mountain Care Board, and the board will review OneCare’s budget. Act 113 is still going through a rulemaking process, he said.

Todd Moore is chief executive officer of OneCare. Photo by Erin Mansfield/VTDigger

“I’m a big proponent of transparency, and I’ve been on the record many times saying that this (all-payer model) can only work if there is strong transparency and public access to what we are doing,” Moore said.

Moore said he is working with Mike Fisher, from Vermont Legal Aid’s Office of the Health Care Advocate, and other stakeholders to reach a compromise on the bill. The Senate Health and Welfare Committee has scheduled additional testimony for Friday.

“We are in the middle of discussions, but I am of course supportive of efforts to help OneCare be as transparent and accountable as possible in their decision-making process,” Fisher said Monday.

“We’ve suggested things like, noticing meetings and agendas, definition of a meeting, being tighter on why they might go into an executive session, making sure (there are opportunities) for public comment, and publishing minutes,” Fisher said.

“I think OneCare sees itself as being transparent, and from the consumer advocate side, I am going to be continually be asking for and pushing them to practice that — both in how they run their board meetings, and in the outcomes of this contract with Medicaid,” he said.

Ayer said the bill is important because OneCare — or the VCO — will eventually be paid most of the Medicaid, Medicare and commercial insurance money that goes through the state. “I worry that at some point we’ll consider them too big to fail, and we may not understand where the money is going,” she said.

But Ayer added that she’s optimistic about the outcome of the all-payer model. “I actually think it’s going to be fine, but we owe it to Vermonters to insist on transparency,” she said.

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Erin Mansfield

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  • Charlotte Rutz

    Let’s keep the pressure on to get them to have open meetings! Transparency–dictated by those who are *not* One Care ACO insiders, that is–is sorely needed. I’ve been following the news around Dartmouth-Hitchcock and more specifically its outbound CEO Jim Weinstein (as I live in that area as opposed to nearer to UVM) and the levels of spin and nonsense put out are astounding. Seems they’re not too keen on facts and reality over in Lebanon; safeguards such as the open meeting law become important when contending with such a fact-averse environment. Of course we can expect the pushback from the One Care crew that was described in the article, and of course no law is perfect, but it’s still worth a try.

    • Neil Johnson

      It won’t happen, they don’t do it in Montpelier as it is, this is why we got a D- in ethics for their own governance. Yet they want your car inspection to include pictures and video. Perhaps all interaction with lobbyists should be videoed.

      • Charlotte Rutz

        I know it won’t happen, ethical or transparent things hardly ever do. But I still had to say I wished it would…

  • Dave Bellini

    Open all the meetings

  • Louis Meyers, M.D.

    Our tax dollars will be paying for the care provided through the OneCare Vermont.
    To say that it is not a public institution is disingenuous. These meetings should be open to the public.

  • Gail Graham

    I have lots of thoughts on my mind, but first is WHY is One Care resistant to open meetings, other than for personnel issues, etc.? I am Medicare, and a not so happy client of One Care. It is managed care! For those that aren’t aware of what managed care really entails, I’ll try to (briefly) explain, although it is not a simple explanation. The bottom line is that the doctors are compensated for ordering/performing the least amount of exams/procedures possible. Therefore, “based on the quality of care they provide, not quantity of procedures performed”. I am NOT saying that the doctors should order lots of tests, etc., BUT that should not mean they aren’t allowed to order (once) routine tests during an annual exam. Performing basic tests sometimes reveal health issues that would not present symptoms until treatment might not be effective. I consider basic evaluations to be part of preventive care, but the hierarchy of One Care do not agree with me. I have attempted to discuss it with them in the past. I have not had a chest X-ray for at least 10 years, and I was a smoker, so I will have to present with a “chronic cough, etc.” to (maybe) have a chest X-ray ordered, BTW- I am also a (retired) nurse, so I do know a bit about “Healthcare 101”. I have also dealt with managed care, ie. HMOs, professionally, in the past, but that that is yet another long story. I would be more than happy to discuss further, if any folks involved so desire. Yes-I’m VERY passionate about this subject!

  • James Rude

    Bad precedent if allowed. One Care is a private corporation and if this practice extents to this particular organization, what keeps it from applying to all private corporations that have contracts with public funding sources?
    Also, a Board meeting should be allowed to take place in such a way that open and free discussions can occur among Board members without concern about trying to censor what is being said in fear that something will taken out of context, be highly susceptible to distortion, and open to special interest group manipulation.
    Disciplinary issues, performance management and compensation practice, hiring decision, risk management issues, positions to taken on lawsuits, etc. are frequent discussed at Board and Board committee meetings and are inappropriate for open forums. Unlike public boards whose members are ofter representatives from special interest or geographic areas, Private Boards are made up of people who act as consultants to senior management insuring the overall linkage of mission, strategy and overall performance of the enterprise.

    • Louis Meyers, M.D.

      And again I would remind everyone that those “private consultants” you mentioned will be expensive and will be paid with tax dollars.

  • Neil Johnson

    While we worry about the open meetings that largest, strongest, most influential monopoly Vermont has ever created will not only be in charge of our health, but one of the largest swaths of money ever done. There will be no other choice for Vermonters on health care. Your raises for the next 10 years will all be taken by health care expenses like the last 10 years.

    We actually have the answer, it’s called captive insurance. We’d be able to cut our costs in half, or better, like every other industrialized nation. Instead we’ll have free health care where they do multiple x-rays for your visit about your cold, and we’ll all wonder why our rates are so high…’s all an inside deal.

  • sharon gutwin

    If One Care accepts any taxpayer money, it should have OPEN meetings. “Being transparent” has very little meaning to the Medical Center. If One Care wants to run like a private business, then have them run 100% on their own dollar, like all other private businesses. But, if we really care to encourage innovation and lower rates in health care, we must dismantle the monopoly.

  • walter carpenter

    “If One Care wants to run like a private business, then have them run 100% on their own dollar, like all other private businesses.”

    Good point, Sharon

  • Dianne Swafford

    What are they afraid that the public will find out ???