Editor’s note: This commentary is by Vermont state Auditor Doug Hoffer.
[T]he State Auditor’s Office serves Vermonters by ensuring that state government and entities that receive taxpayer funds are operating effectively and efficiently. As such, I would like to clear the air about some misinformation regarding my office and my intention to audit Vermont’s accountable care organization (OneCare Vermont). Some have expressed concerns about the need for such an evaluation and our authority to do so. Here are the facts.
OneCare Vermont is part of a national experiment blessed by the federal government to change the way health care is provided and paid for. Although other states are going down this road, our ACO will be a virtual monopoly, receive hundreds of millions in public funds, and eventually touch the lives of most Vermonters. That is sufficient reason to conduct periodic audits on behalf of Vermonters.
The State Auditor’s Office has numerous responsibilities. Our primary function is to conduct performance audits of state government. The state auditor may “at his or her discretion, conduct governmental audits … of every department, institution, and agency of the State” (emphases added; 32 V.S.A. § 163).
Part of that responsibility includes auditing the performance of entities that are paid by the state with public funds. Such audits typically include a review of the state’s management of such contracts and, in some cases, may include a review of a regulatory entity’s performance of its duties.
OneCare Vermont has a huge contract with the Department of Vermont Health Access to provide care to part of the state’s Medicaid population. The current annual value is almost $100 million.
The auditor’s authority is reflected in state contracts that include audit provisions requiring the contractor to retain and make available on request all records related to performance under the terms of the contract. This is true of the OneCare Vermont contract for Medicaid.
Therefore, contrary to what some have suggested, the state auditor already has the authority to audit OneCare Vermont. The confusion arose from a bill introduced in the House at my request (H.181) that would provide expanded access to records from OneCare Vermont. I thought this would be useful because: 1) OneCare is a very large for-profit corporation that is part of a complex web of other entities affiliated with the University of Vermont Medical Center (i.e., it could be challenging to track the flow of funds), and 2) OneCare (like other powerful private entities) can be expected to contest some of our records requests, and such disputes are distracting and delay our audit work. The point is that I want nothing more than the tools necessary to do the job of ensuring that public dollars are used effectively and efficiently to provide critical services to Vermonters.
Furthermore, and contrary to what some have said, I have no interest in regulating the ACO. That is the job of the Green Mountain Care Board. Our job is to conduct independent performance audits.
To some extent, the misinformation about H.181 reflects the fact that the health care industry spends more on lobbying than any other interest group in Vermont, as reported by VTDigger. That is their lawfully protected right, but, in this case, it’s troubling if the goal is to limit transparency and accountability. What’s more, if OneCare is performing well, why wouldn’t it welcome an independent review?
The shift from fee-for-service to the so-called “all payer” model has a lot of potential, along with some risks. Notwithstanding the Green Mountain Care Board’s ongoing oversight, an experiment of this size and complexity requires multiple sets of eyes. Indeed, it would be irresponsible to claim otherwise.
I fully expect that the auditor’s office will devote resources to this subject for years to come, including a review of the role of the board. The Legislature, which established and relies on the board, does not have the resources to evaluate this work, so we will fill the gap.
Finally, the auditor’s office has exceptional staff with considerable experience auditing complex subjects. I am confident we can do the work and add value.
