[V]ermont still has a long way to go to transform the state’s health care system, according to a new survey of health care providers across the state.
The Green Mountain Care Board, a regulatory body responsible for hospital budgets and insurance prices, published the results of the survey Thursday.
The board has been working with the Department of Vermont Health Access, hospitals and other stakeholders to steer a $45 million grant aimed at transforming Vermont’s health care system.
The reform in question is based around companies called accountable care organizations. The federal government allowed for these companies to be created under the Affordable Care Act so doctors could coordinate patient care without violating antitrust laws.
In Vermont, the state has used a portion of the $45 million State Innovation Model, or SIM, grant to help set up three accountable care organizations. The grant started in 2013 and expires at the end of the month.
The three companies are OneCare Vermont, owned by UVM Medical Center and Dartmouth-Hitchcock Medical Center; Community Health Accountable Care, owned by community health centers; and HealthFirst, owned by independent doctors.
The survey shows that about 9 out of 10 primary care providers who responded — most are part of one of those three ACOs — thought that health care reform had negatively affected care or not affected care, or they didn’t know whether reform affected care at all.
The primary care providers included doctors, nurse practitioners and physician assistants who worked in family medicine, internal medicine, pediatrics, obstetrics and gynecology, but not who worked in hospitals or urgent care centers.
Three hundred twenty-five completed the surveys. A phenomenon in statistics called response bias means that people who are most worked up about an issue tend to respond to surveys, so surveys may not always represent the general population.
Specific results follow:
• Ninety percent of providers who responded either think the latest health care reform efforts have not changed the quality of their services, have made quality worse, or don’t know.
• Eighty-nine percent of providers who responded said they perceived that the reform efforts have had no change, have had a negative effect, or they do not know what effect the reform efforts have had.
• Ninety-four percent said the latest form of health care reform has either not helped reduce health care costs, have made health care costs worse, or they don’t know whether it can help reduce health care costs.
• Only 2 percent use data from the accountable care organizations often, and 13 percent use it sometimes. The remaining 85 percent either rarely use it, never use it or don’t know if they use it.
• Thirty percent of providers said they were not at all ready for being paid based on their performance, and 17 percent said they were only a little ready for being paid based on performance.
“Real health reform is going to rely on buy-in from especially primary care doctors, and if they don’t see any benefit to this, there’s just a million ways that they don’t participate,” said Patrick Flood, who was involved in these efforts before retiring in 2016.
“They don’t use the data; they don’t send in data; they don’t follow certain protocols,” Flood said. “I’m reading between the lines on that a little bit, and it looks like they aren’t” doing those things.
“This was one of our leading parts of health care reform, and this is money the feds gave us to create, basically, a new system and get ready for the all-payer model, and I think it’s all just petered out,” Flood said.
“If I’m wrong I’d be happy to be wrong,” he said. “I’d be happy for someone to show me the dramatic improvements in health care and the achievements in health care reform that came with that money.”
“It’s more likely we could disprove it,” Reiss said. “I guess the question is, ‘How long should we keep working at it before we discount it as the way to go, or write it off as not the ideal model for Vermont?’”
He said: “Across the country, ACOs have been successful when they’re physician-led and where they exist in high-cost places that have alternatives, and we don’t have that in Vermont.”
Reiss said providers have shown success on improving quality, but not on lowering costs, “because we were already a very low-cost area and it would’ve been very hard to improve on that.”
Georgia Maheras, Vermont’s deputy director of health care reform, also said the ACOs are doing well on quality. However, she said the state would need three to five years of data to show whether costs are going down.
In addition to the provider survey, Maheras said the state organized focus groups, interviews and other types of data collection. A final report on the $45 million grant will be available in the next few months, she said.
Maheras said the federal government would also perform an evaluation on the grant. She said ACOs need a lot of money for technology and care management to start up, and the federal government will be reviewing what kind of infrastructure is needed.
Cory Gustafson, the commissioner of the Department of Vermont Health Access, said the state remains committed to broad health care reform goals — changing the way doctors are paid and therefore changing economic incentives, and reducing fragmentation in the health care system.
Gustafson said the state remains on track to keep implementing the all-payer ACO model agreement with the federal government on Jan. 1. The yearlong reform project through Medicaid is going well, he said, and the state is talking to OneCare about another contract next year.
“Our commitment is really to continuing down the path of addressing incentives and fragmentation in the system,” Gustafson said. “I don’t think anyone wants to leave the system as is. Anyone who talks about health care in the country or in the state of Vermont says we need to look to improvement.”
The Green Mountain Care Board will give a presentation on this survey at its meeting Thursday at 1 p.m. in Montpelier.
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