Editor’s note: This commentary is by Dr. Joseph F. Hagan, who practices primary care pediatrics at Lakeside Pediatrics in Burlington and is clinical professor in pediatrics at the University of Vermont College of Medicine and at the UVM Children’s Hospital. He is a physician member of the University of Vermont Medical Center board of trustees. While Hagan had been on the Board of Vermont Managed Care, his only relationship with OneCare Vermont is that of participating physician. The view expressed is his own.
Recent VTDigger commentaries allege failure of Vermont’s health reform initiative to meet one of its stated goals: We have not increased the number of primary care practitioners available to serve Vermont’s children and adults. The commentaries makes an important point, but I believe a misleading one. It is more accurate that we have not yet reached this goal. OneCare Vermont is our state’s premier accountable care organization (ACO) and OneCare’s leadership is taking important and significant steps to strengthen and enhance primary care while also working to make Vermont’s health care sector an attractive place for primary care providers want to practice.
I have practiced primary care pediatric and adolescent medicine in Chittenden County since 1979. For my entire career I have been active in the training of pediatricians, family medicine physicians, and nurse practitioners in both specialties, both locally and nationally. I have participated in every managed care program that Vermont has ever had.
Only Vermont Managed Care, the organization that preceded and developed OneCare, succeeded in providing quality care and modest cost containment. The failure of every other managed care program was predictable. Some were so poorly conceived that they were doomed before any patient was enrolled. Most struggled soon after they started, having misread the Vermont market or by mismanaging their resources, notably their primary care clinicians. OneCare has emerged as the primary implementer of health care reform.
OneCare is doing extremely well as it completes its third year. Has it met every goal? Of course not. Establishing quality health care for all of Vermont’s residents is an extremely complex task. Solutions to make that care affordable has eluded every health care administrator, legislator, and governor during my career. But now OneCare is taking important steps to achieve these goals. And they are evolving systems to strengthen primary care practices in ways that are meaningful and hold great promise. As a private practice practitioner in primary care, I see numbers that make sense and payment plans that reward primary care clinicians who provide care that is compassionate, patient and family centered, and evidence based. And importantly, I see a system that finally recognizes the complexity and the time required for the primary care for children and adults with behavioral health and special health care needs.
Vermont State Employees’ Association and Vermont National Education Association should participate in OneCare in their next contract. I believe that not participating is the wrong choice for the primary health care of their members. It is the wrong choice for their specialty and hospital care as well. And it is an unfortunate choice for the rest of the state’s patients. An ACO is a system of care. To fully achieve the ACO triple aim to improve access to care, improve health outcomes, and reduce costs, ACOs like OneCare must become a system of care for a population.
OneCare must have increased enrollment of patients to meet these goals. I urge the Legislature to respond to the Green Mountain Care Board’s recommendation for increasing our investment in OneCare. Patience and support are needed to give this model the time to work. Admittedly this is yet more cost, not for administrators or stockholders but rather to bring needed reforms to how services can be provided for our patients. I see this as an essential investment. Have we not yet learned that if we don’t pay to build a functional system of care now, we will pay much more later?
