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.
“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.
“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.
“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.