About 160,000 Vermonters, roughly a quarter of the state’s population, have their health care funds pass through OneCare Vermont. For the most part, the company flies under the radar.
In fact, nearly a billion dollars of state health care funds go from insurance providers to the for-profit accountable care organization; OneCare then funnels the money to doctors and hospitals.
OneCare helps facilitate the state’s all-payer system, which prioritizes preventative care and aims to lower health care costs by keeping people healthy.
State health officials and OneCare are trying to add, or “attribute,” as many Vermonters as possible to the project. OneCare aims to have 70% of eligible Vermonters in their programs by 2022, the end of the five-year pilot. The organization currently has about 160,000 members, about 100,000 people below its 2019 scale targets.
So who’s already part of the OneCare system? And if you are part of it, how would you know? Here’s how to tell whether you’re one of the “attributed lives” that make up OneCare’s patient population.
So I think I’m in OneCare. Does it make any difference to my healthcare?
Ultimately, there’s not much of a difference for individual patients, according to Amy Bodette, OneCare’s director of public affairs. OneCare is trying to change the way health care is paid for — they’re transitioning to paying doctors a monthly fee for each patient rather than for each procedure. The idea is that will incentivize health care providers to keep their charges out of the hospital by keeping them healthy.
OneCare is doing that through wellness programs; they started a nonprofit, RiseVt, which is offering exercise classes and free vegetables to those who need them. OneCare is gathering more data, keeping track of the number of Vermonters who have diabetes, got into alcohol or drug treatment programs, or had a check-up within the last year. They’re sharing that information with doctors as a way to help improve care. OneCare is also helping doctor’s offices hire care coordinators, which help connect patients to other services in the community.
But all those services are available to everyone, regardless of whether they’re in OneCare or not. “A lot of the work we’re doing is to enhance what they can offer, and enhance the information they have and the data they have, and that will result in better care for the patients,” Bodette said. “Our relationship is really with providers.”
Are there any benefits of being in OneCare that aren’t available to everyone?
The University of Vermont Medical Center is offering DNA testing to some of its patients. That option is only available to individuals who are in OneCare and see certain primary care doctors.
OneCare has also negotiated certain deals with Medicare and Medicaid to save time and money for enrolled patients.
Most Medicare patients who want rehab to be covered by insurance have to first spent three days in hospital. OneCare has negotiated a waiver so that they can go straight to rehab — only for its members. They also have a “prior authorization waiver” with Medicaid. Rather than checking with Medicaid to see whether they’ll pay for a procedure, the doctor can just provide the care and then bill Medicaid, no questions asked.
These tweaks save paperwork for doctors and “frees them up to have more time” to see patients, Bodette said.
Should I be worried?
Depends who you ask. Representatives from OneCare say there’s no downside. But Richard Davis, a semi-retired nurse and a Guilford resident, said he’d rather not participate for philosophical reasons. “The bureaucracy that got created in Vermont, it’s too much; there’s no accountability,” he said of OneCare. “They don’t have an obligation to the public.”
That system has left him distrustful. “I don’t want to be part of something that operates that way,” he said.
He tried, but wasn’t able, to opt out of OneCare entirely. Davis is not the only one: two state unions expressed similar reservations recently about having their members join OneCare.
If I hadn’t read this article, how was I supposed to find out about this?
Great question. You were supposed to receive a letter from OneCare when your doctor or medical center joined the accountable care organization. The message notified you that you were in the system, and laid out the details. There’s a chance that letter is still sitting in that massive pile of junk mail that’s been accumulating for months.
Do I have any choice in the matter?
Not really. According to Bodette, doctors, not patients, are ultimately deciding whether they take part in OneCare. Each doctor and hospital can decide whether to participate and which insurance to include — Medicare, Medicaid, or private. When a provider joins, his or her patients are automatically in.
You could get out of OneCare by changing your primary care doctor to someone who has decided not to participate in the system. But ultimately, more and more doctors will be joining OneCare and the all-payer system, so that may not work forever.
OK. Is there anything I can do to opt out?
You do have the option to not to share your claims information with OneCare. That means the organization won’t be able to see your diagnoses, treatment and billing information — but you’ll still technically be in part of the system. You can contact OneCare to opt out of sharing the information.
Mike Fisher, the state’s health care advocate, said that his office is working to make sure people understand their options to opt out. As is, the process can be onerous, according to Davis, the dissatisfied patient. “Unless you’re very persistent and a total pain in the ass like I am, you’re not going to figure this out,” he said.
