Editor’s note: This commentary is by John Klar, who is an attorney, farmer and writer from Brookfield, and a candidate in the 2020 Republican primary for governor.
OneCare Vermont is a novel effort to unify health care services in the Green Mountain State under what is called an “accountable care organization” (ACO). This experimental system is defined as a “… new test of an alternative payment model [designed to] … transform health care for the entire state and its population.” Health results are impossible to gauge in the short term, but criticism has been directed at OneCare’s alleged failure to provide documentation of services, even as it seeks an additional $4.5 million in state funds for its next fiscal year.
Doubts are justified: this accountable care organization does not appear to want to be held accountable. Though it is not a nonprofit entity, its director of finance, Tom Borys, recently stated that “… OneCare is not seeking a profit.” But by this is meant that OneCare is a for-profit corporation that is losing money, and it seeks more taxpayer funds to assure that it breaks even.
Someone is definitely profiting — OneCare apparently pays $11,776,602 in salaries and benefits to 77 employees, which would average $152,942.88. The actual salaries are unknown to the public: OneCare refuses to disclose them, “… and refused to open up its books to public scrutiny and fought a change in state statute that would have given the state auditor expanded access to financial information.”
The salary figures look suspicious — the company expended $19,276,749 out of $62,392,815 on administrative costs last year, or 30.9%. When Borys was asked “… how much is an appropriate portion of overhead, he said he didn’t have an exact figure.” Not a very accountable organization — no records of alleged programs for which the public was charged; a refusal to disclose salaries; high overheads, but no “exact figures” on what is a reasonable level of administrative expenses.
These overhead margins would be quite high for a charitable organization (that was not seeking a profit): charities typically spend 15% on overhead and 10% on fundraising. Since OneCare gets its funding directly, it appears to be spending about twice what a nonprofit would spend on overheads. That it is spending 61.1% ($11,776,602/$19,276,749) of that overhead on salaries is quite unusual — such a high proportion of salaries is more likely to be found in an accounting or law firm.
A Vermont citizen might thus query whether that $19,276,749 might have better served patients than administrators.
The watchdog of OneCare Vermont is the Green Mountain Care Board, which is described this way by the governor’s office:
The Green Mountain Care Board (GMCB) is an independent group of Vermonters charged with ensuring that changes in the health system improve quality while stabilizing costs. The Legislature assigned it unprecedented responsibility for all the major factors influencing the cost of health care.
VTDigger is underwritten by:
But this “independent group of Vermonters” is paid quite well to serve as the administrative body that oversees the administrative body (OneCare) that oversees our health care system to make it less costly. GMCB Chairman Kevin Mullin receives $158,620.80 annually; the other four board members receive $105,747.20. Total Green Mountain Care Board staff salaries approximate $3 million annually (the state employee website lists 33 employees at Green Mountain Care Board, which would average about $90,900 each).
Mullin touts (“independently,” of course) the virtues of OneCare. Hopefully, he and the Green Mountain Care Board will disclose OneCare’s salaries (how else to evaluate whether it is fair to grant another $4.5 million in state funds?). Also, Mullin will doubtless examine what expenditures were included in these other (p. 21) OneCare Vermont administrative accounts:
contracted services $1,173,970; software $3,726,889; travel $103,250; occupancy $456,859; other $485,500; meetings $35,700, professional development $103,238; risk protection $1,075,912.
OneCare’s CEO, Vicki Loner, contends that “OneCare has made significant efforts to bring in news organizations, policy makers, and other interested parties to answer questions and share information. All combined, OneCare has invested hundreds of hours to be a transparent organization.”
Those hundreds of hours are paid for by taxpayers (all combined). It would likely take only 15 minutes (all combined) to provide salary information relating to the employees of what is essentially a quasi-state entity.
Vermonters are burdened with increasingly unbearable property taxes. Health care costs skyrocket, state worker pensions are substantially underfunded, and yet the government creates more and more employment for state agencies. Examining the track record of entities like OneCare Vermont, citizens are doubting whether AnyoneCares, especially within the bloated dome of the Montpelier Legislature.