Editor’s note: This commentary is by Julie Wasserman, MPH, of Burlington, who is a health policy consultant. She has worked for Vermont state government in a variety of capacities including director of Vermont’s Dual Eligible Initiative, division director of policy and planning for the Vermont Department of Aging and Disabilities, and as legislative staff to Vermont’s Senate Health and Welfare Committee.
[T]he UVM Medical Center and its ACO, OneCare Vermont, have positioned themselves as Vermont’s pre-eminent health care network. In this role, they are leading Vermont’s health care reform efforts with a promise of improved population health through a five-year experiment to change the face of health care. “We are on our way to a statewide network that focuses on primary care and population health for all Vermonters,” stated Todd Moore in a 2018 press release. To accomplish this, OneCare hopes to reward doctors for keeping their patients healthy and “improve Vermonters’ well-being.” (Todd Moore is UVM Medical Center’s senior vice president of strategic revenue, and CEO of OneCare.)
OneCare has extolled the virtues of “primary care” as a mechanism to achieve these important goals. Primary care is the single point of contact for patients needing care. It provides the necessary health promotion, disease prevention, and health maintenance required to keep people healthy. However, the reality of UVM/OneCare’s “primary care network” paints a different picture.
A good friend of mine noticed a suspicious lump on his torso. He made multiple calls to UVM’s Adult Primary Care clinics to obtain an appointment. He is considered a “new patient” because his longstanding family physician recently retired. My friend was repeatedly told that “new patient” appointments are essentially unavailable. Even though Chittenden County has the highest concentration of physicians in the entire state, an appointment for a compelling medical need was elusive. One wonders if other people have experienced this same difficulty. Vermonters need and expect ready access to primary care.
UVM’s Adult Primary Care clinics reported the following:
• Burlington (Given) offered an appointment in October or November
• South Burlington (Aesculapius) offered an appointment for August 2019, a year from now
• Williston reported they were “booking out a year”
• Milton – “eight weeks out”; Hinesburg “2-6 months from now”
• Essex Junction stated, “We are not taking new patients. Our practice is full.”
The staff at these clinics told my friend to go to the emergency room or a “walk-in clinic.” Neither would suffice. Seeking primary care in the emergency room or a walk-in clinic are poor choices since neither option affords the patient comprehensive, coordinated and ongoing care required for a potentially serious illness.
The state of Vermont also has a role in supporting primary care. However, the governor’s budget for fiscal year 2018-2019 recommended $3.86 million in cuts to primary care doctors and community health clinics, and elimination of loan repayments intended to encourage medical professionals to practice in Vermont. Fortunately, the Legislature rejected these cuts.
Primary care constitutes the core of a robust health care system. Without it, health care reform efforts attempting to improve population health and lower costs will not succeed. Rather than fund the start-up and infrastructure costs of ACOs such as OneCare who have been given almost $15 million* in state-authorized funds to date, the state would be better served by investing in the recruitment and retention of primary care physicians.
* Start-up and Infrastructure Costs of ACOs to date:
• Vermont state budget FY2018-2019: $2,625,000 for OneCare
• Department of Vermont Health Access contracts with OneCare in FY 2017-2018: $6,856,000
• State Innovation Model 2014-2016 (SIM grant) $5,232,000: ($4,337,000 for OneCare, $841,000 for CHAC, and $54,000 for Healthfirst)
