The administrative organization that was created to handle the all-payer health care model will pause while it re-evaluates its vision and priorities, but will not fully suspend operations.
The board of directors for the Vermont Care Organization, or VCO, voted Monday not to suspend operations, even though the board’s executive committee had recommended doing so less than three weeks ago.
“We’re going to continue to meet, but we’re going to take some time to really look at our vision and our priorities over the next while and report back,” said Tom Huebner, the chief executive officer of Rutland Regional Medical Center and the chair of the VCO board.
Huebner said the VCO board has appointed a panel that will look at the role of the VCO in health care reform and report back to the full board before Dec. 15. He said they will likely be done with their work well before that date.
Meanwhile, the chief executive officer of the VCO will be spending his time elsewhere.
The VCO is an umbrella organization that the Green Mountain Care Board spent two years helping to create. The goal was to get all primary care doctors in the state encompassed under a single organization so they could coordinate patient care.
The VCO started in July as a management company that would help merge two of the state’s largest health reform companies—OneCare Vermont, which is jointly owned by the two local academic medical centers and represents hospitals, and Community Health Accountable Care, which is owned by Bi-State Primary Care and represents community health centers.
The majority of the members of the VCO board have been members of the board of OneCare. Other members of the VCO board represent smaller groups of providers, such as community health centers, quasi-public mental health agencies, and independent doctors.
Todd Moore, the senior vice president of revenue strategy for the University of Vermont Health Network, has been serving as the chief executive officer of both OneCare Vermont and the VCO. He says he will now spend less time running the VCO.
“From my perspective, the primary mission of the VCO was the operational integration of OneCare and CHAC,” Moore said. “The timing just doesn’t seem right to go further on that right now,” he said, because “all parties” are not ready to take the next steps toward becoming a single health reform company.
“Certainly it’s been a coalition that we’ve tried to build and we’re still trying to build enough trust that we truly could envision a single enterprise,” he said. “We just aren’t quite in a position to take the next step that, in my mind, would be a truly unified organization.”
Going forward, Moore said he would spend more time running OneCare, which he said the OneCare board also expects of him. He said OneCare and Community Health Accountable Care will continue working together in some ways, but remain operationally separate.
“I’ve offered certainly to give them (VCO) updates on anything we’re doing at OneCare Vermont,” he said. “Maybe the original mission will become a possibility at some point in the future.”
Huebner, the board chair, said the future of the VCO hinged on whether they could secure $209 million in Medicaid money—roughly half state money and half federal money—over five years for Medicaid programs, such as case management, administration, and information technology.
Former Gov. Peter Shumlin’s administration had estimated in October, when the state first signed the all-payer contract with the federal government, that the VCO needed the $209 million to start up.
“The issues were really with lack of financial support that we thought we were going to get from the government,” Huebner said. He said not getting the money “really caused us to reexamine what our role should be.”
Huebner said the VCO may be able to secure startup money from other sources. Otherwise, they would need to live within the money they have, and figure out the best way to do that.
“We still very much believe in the all-payer model, but we may have to do it in a different structure than we originally thought,” Huebner said. “But we haven’t given up trying, is the point.”
Dr. Paul Reiss, who represents independent doctors on the board of the VCO, said the board’s subcommittees on population health, primary care, and finance will suspend operations.
Reiss will sit on the panel that looks at vision and priorities. He said he hopes to have a clear idea of what the VCO should be by the middle of the summer.
“I would like to see a statewide collaborative organization that truly puts the patient and the whole delivery system first,” Reiss said. “That’s what VCO’s mission is, and that’s what VCO was intended to do.”
“However, we have not been able to move it to the point where it’s functional in that role, (in which) all parts of the delivery system can agree to the same actions and activities going forward,” he said.
The Vermont Legislature passed a law, S.4, on May 2 that will require the VCO, OneCare, and Community Health Accountable Care to hold open board meetings whenever they take binding action. If it becomes law, the open meeting requirements will go into effect July 1.
Mike Fisher, the chief health care advocate for Vermont Legal Aid, said he and his staff would continue to support transparency in health care reform, whether the VCO exists or OneCare and Community Health Accountable Care work separately.
“We will continue to advocate for transparency and for patients to understand the motivations behind their health care,” Fisher said.
