Health Care

Green Mountain Care Board approves $1.42 billion OneCare budget

Kevin Mullin
Green Mountain Care Board members listen as OneCare Vermont officials present their budget proposal for next year at a meeting in October. Photo by Mike Dougherty/VTDigger

Health care regulators approved a $1.42 billion budget for OneCare Vermont, a 59% increase over last year. The growth reflects the increase in size in the accountable care organization, which has been charged with enacting the state’s health care reform efforts. 

The five members of the Green Mountain Care Board voted unanimously in favor of the budget — which included 23 conditions — on Wednesday. They requested that OneCare create an online dashboard by next summer to increase transparency and allow the public to see health data results. 

OneCare Vermont has been charged with implementing the state’s all-payer health care system, which was launched in 2016. The company collects money from insurers and then funnels it to hospitals and providers, paying them a set amount for each patient rather than for each procedure. They provide data and analytics, coordinating care and finding new ways to keep people healthy. The effort aims to improve care and reduce costs by incentivizing doctors to keep patients healthy. 

OneCare is the state’s sole accountable care organization and its budget and purview has grown steadily in the past three years.

Last year, the organization’s budget was $906 million. The increase this year largely reflects an increase in hospitals and doctors that joined the program. The 2020 budget includes $19 million in administrative costs and $43 million in investments in primary care and community programs. 

The majority of the revenue, a total of $1.36 billion, passes through OneCare to doctors and hospitals to cover care. 

With the vote, regulators signaled its commitment to the reform efforts, even though they don’t yet have results on whether it’s working. Board member Tom Pelham emphasized the experimental nature of the health care system. “It may work, it may not work,” he said. “We don’t have any idea about that.”

It will take “a few years” before the board — and Vermonters — know for sure, agreed board member Maureen Usifer. “We need to be patient.”

Usifer assured the members of the public that the board is overseeing OneCare. The nearly two dozen conditions it issued with the budget reflect that commitment to accountability, she said. 

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Those conditions mean that OneCare must report back to the board throughout the year. Early next year, OneCare must update the board with the final totals of how many people will participate in its programs.

OneCare has vowed to increase the number of Vermonters and doctors who participate in its programs by more than 50% — from 160,000 in 2019 to 250,000 in 2020. 

Ultimately, OneCare aims to include the entire state in its data and investment efforts. So far, the company is behind on its targets.They currently include about a quarter of Vermonters; they’re supposed to reach 58%, roughly 300,000 people, by the end of 2020. 

OneCare representatives did not weigh in at the meeting. 

Board members highlighted their efforts at increasing the transparency around OneCare’s performance and results.

They asked OneCare to create a dashboard to make the data more accessible to the public — though so far, it doesn’t have enough statistically significant data to draw results.

That dashboard will help Vermonters buy into the model, said board chair Kevin Mullin. “How do Vermonters feel comfortable making changes that … may or may not work?” he asked. “There has to be transparency and there has to be accountability and that’s what the dashboard is going to provide.”

Green Mountain Care Board members and staff emphasized that the data that exists can’t be used to draw conclusive results about whether the all-payer system is working. “How do we know if OneCare is improving quality for patients and providers? We don’t,” said Marisa Melamed, associate director of health care policy for the board. “We only have one year of data.”

OneCare officials
OneCare Vermont officials present their budget proposal to the Green Mountain Care Board in October. From left: Vicki Loner, CEO; Tom Borys, director of finance and Sara Barry, COO. Photo by Mike Dougherty/VTDigger

OneCare must also submit a work plan to evaluate the effectiveness of its population health investments by the end of June. OneCare previously failed to track its investments in community health programs, the state auditor reported in a memo in October. 

The organization “did not reliably monitor or accurately report” the community-based initiative it promised to fund, including providing fresh produce to patients and helping to coordinate care, the auditor wrote. 

The care board also required additional reporting around OneCare’s finances.

The budget includes $13.1 million in state and federal money, though a portion of that money must still be approved by the Legislature in the upcoming 2020 session. If OneCare doesn’t receive the cash, it will have to come back to the care board and address how it will restructure its budget.

Care board members also addressed public concerns about the $19.3 million in administrative expenses, including $11 million in salaries for 77 employees. Currently that total makes up 1.4% of the total budget. If revenue increases for OneCare, the company must keep administrative costs below 1.35% of its total budget. 

Such administrative expenses may be necessary for changing the health care model in Vermont, said Melamed. “We need to put administrative money in to be able to administer these changes,” she said. The overhead costs by OneCare can help save money for hospitals and practices, Melamed added.

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The board also requires that OneCare’s administrative expenses must be less than the savings it generates, though board staff noted that they did not yet know how to measure that. So far OneCare has not generated systemwide savings.

In spite of the unknowns, critics of OneCare should wait and see, said Pelham. 

He encouraged skeptics, including “people who don’t want government” as well as “single-payer diehards,” to be patient with a previously untried approach to health care. “This is a test and I think we should keep this in mind going forward,” Pelham said.

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Katie Jickling

About Katie

Katie Jickling covers health care for VTDigger. She previously reported on Burlington city politics for Seven Days. She has freelanced and interned for half a dozen news organizations, including Vermont Public Radio, the Valley News, Northern Woodlands, Eating Well magazine and the Herald of Randolph. She is a graduate of Hamilton College and a native of Brookfield.

Email: [email protected]

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Jenny Kingsbury

Big. Mistake.

Sandy J Rhodes

A dashboard? This is Vermont, a rural state. Many folks hardly have cellular service, even less, internet. They are not internet savvy. So, how do they think these folks are going to understand a dashboard if they can access it. 2.4 billion dollars? Who’s going to play watchdog? That’s 12 times what Quiros and his political cronies had; a couple of hundred millions.

Louis Meyers, M.D.

At the risk of being repetitive, I would take issue with Mr. Pelham’s assertion that the OneCare is “an untried approach.” It has been tried by several other states in recent years and it has never been shown to save money or fundamentally improve health care.
This is beginning to remind me of Pete Seeger’s anti-war song “The Big Muddy”- in which he sings:
“We were neck deep in the big muddy and the damn fool kept yelling to push on.”

Roger Brown

This is really hard to believe. We have been patient with reform efforts. And they have been a disaster. Non functional websites, double digit annual cost increases, uninsured numbers rising again. And we gave a billion dollars last year to an organization that we didn’t even know how to evaluate? And are giving them almost a billion and a half this year?

But wait and see. We have to be patient. It’s a nothing burger.

Why dont we implement some strategies that are shown to reduce costs – like reducing consolidation?

GMCB, you are our representatives in this. You have to hold the hospital network, acos and the insurers accountable. Please do your job.

Karen McIlveen1

The buddy system works against VT once again.

James Taylor

The more money we throw at this, the less accountable the disease managers become.

Robert Roper

“OneCare has vowed to increase the number of Vermonters and doctors who participate in its programs by more than 50% — from 160,000 in 2019 to 250,000 in 2020.” Cramming more people into what appears to be a sinking ship is insanity. Until you’re sure this experiment works, the GMCB should freeze the number of people being dumped into it, and analyze how costs and outcomes compare between those in OneCare and those NOT in OneCare. What they are doing seems like a bureaucratic/political rush to make a crony-driven money-pit too big to fail before the people catch on to the scam and can do anything about it.

Wayne Curley

11 Million for 77 employees: average of 142,857.
Another 8 million for “other” administrative expenses?
I think the public needs to see a specific list positions and salaries and an explanation of the other 8 million of expenses for admin.
The GMCB must have this information because they would be lacking due diligence to approve this budget without it.
Let’s see it.

tom burke

What a waste of monies…thanks GMCB

Jason Pare

Seriously? 1.42 Billion dollars for…..”it may work, it may not work, we don’t have any idea.” and “we are behind our target.” In what world is this acceptable. All these people are screwing the public over. 19 million in Admin costs? Someone is getting rich while we hope this will work, meanwhile once it fails, those with the 19 million won’t worry about the pain of losing this money or leaving the State in disrepair as those with the money will just retire wealthy or move to another State with the money they robbed from the taxpayers.

david schwartz

Not surprised. GMCB is a rubber stamp for UVMMC. Maybe some of the GMCB members can get a job at UVMMC later as a sign of appreciation for their allegiance.

Martha H Molpus

Very disappointed in the Green Mountain Care Board. Vermont deserves better.

Jonathan Heins

Well, the “Care” Board doesn’t seem to care about the misgivings of Vermonters. They have heard from One Care about:
how hard it is to account for all the money the public has given them, how it is difficult to monitor the health benefits, how hard it is to monitor the programs they are payed to monitor, how sad it is that the “experiment” is being criticized, how they will double the enrollment by next year, and on and on and on…..

The “Care” Board does what One Care wants and rationalizes it with rhetoric which only proves that they are “shills” in this game. It’s only 1.4 BILLION. Be patient. So they messed up a little – it’s just an experiment.
This means it is now scientifically proven that it is better to be a “shill” than a patient citizen.
(Wait ’till next year’s request)

Glenda nye

This is an experiment that is what CMS Medicare calls it. We can thank Shumlin for instituting the “All Payer Waiver” Vermont is the ONLY state to adopt the All Payer Waiver. We are going to shell out 1.4 billion dollars yet One Care ACO “previously failed to track its investment in Community Health Programs.” I for one opted out and signed the paperwork to do so, I can opt out because this All Payer Waiver” is an experiment. The GMCB has made the statement they don’t recognize opting out. I had numerous conversations with Medicare in D.C. stating my objection to the All Payer Waiver, it basically is a set dollar amount for each patient, I would liken that to a death sentence. Why don’t you all ask the GMCB why they are commingling Medicare Premium dollars with Medicaid. I fought hard to keep Medicare money separate from Medicaid but to no avail. Get ready folks for another fiasco brought to you by Vermont experimenting with all of us, hold onto your wallets tight.

rosemarie jackowski

We used to be patients.
Then we became customers.
Now we are just victims.
OneCare equals NoneCare.


What a Racket.

Frank Westcott

When will one just one, of our elected officials stand up and tell the truth about one care? The tax payers and insurance premium payers are being swindled! What do we here from Montpelier? Crickets!

don white

If Pelham isn’t aware of other failed attempts at ACO’s he should immediately be removed form the board.

Miriam Fried

Why not forget about the custom computer system scam and put the money directly into healthcare ?

That money could hire 500 doctors working full time at a high wage or nearly 1000 at new doctor starting wages.

Lee Russ

A major goal of the experiment is to eventually lower costs and I have yet to hear a credible description of how it will do that. And on the slight chance that OneCare does–somewhere far, far down the road–reduce costs, will that reduction ever be enough to both cover OneCare’s administrative costs and result in lowering patient costs (premiums, deductibles & co-pays)?

We have taken a commercial insurance model that is drowning in administrative costs, added another layer of administrative costs and now wait to see if this will reduce costs. You don’t have to be someone who doesn’t “want government” or a “single-payer diehard” to question the wisdom of taking this path. In the mean time, the state’s own figures indicate that 39% of Vermonters are either uninsured (3%) or underinsured (36%).

And an average OneCare salary of $142,000? I’m guessing that no one who works for OneCare has trouble affording health care.

Marie Parker

What an expensive “test”.

I am very disappointed GMCB approved OneCare’s requested amount. Then again, it was expected.

Walter Carpenter

“We have taken a commercial insurance model that is drowning in administrative costs, added another layer of administrative costs and now wait to see if this will reduce costs.”

Good way to phrase it. That’s exactly what has been done here. Once again, it is the administrators who are raking in the cash and the patients are the ATM machine.

Peter K Marsh

I agree with you Dr. Meyers. I do IT work across the country in Healthcare and I am not a fan of ACO’s because they have not worked elsewhere. It never resulted in the advertised savings in other places I am familiar with and the idea the administrative costs will save money for the hospitals and others was never realized, just the admin costs were just added onto current costs. Just look at how much the exchange cost VT compared to NH’s, and then ask yourself, why was theirs so much cheaper and it worked while ours was so much more expensive and did not work ?

Doug Richmond

ASTOUNDING Report We don’t know whether it is working, whether it ever will work, and it will take a long long time and $billions to find out?!? And by then, it will have become the Only system, and Nothing can be done about it !!

Where can these Ideas come from? No answer! I believe it is part of the “UVM” Fletcher Hospital and Brumstead trying to create a Monopoly of Health are and these $Billions for his network

How much do the Onecare system and the green Mountain Care board costing now?

jeffrey green

Wake up, folks. Pick your poison. Either OneCare or Blue Cross VT. That’s it. Both are destined for problems, simply because to offer wide ranging medical insurance, efficiently & at lowest cost…you need “scale and scope”….millions of people. Vt offers neither – and never will. VT’s population of about 624,000 will never be efficient – or cost effective. If you want that (affordable premiums) you must open up VT’s insurance market to the largest nationwide health insurers, who HAVE efficency, scope & scale – to offer good insurance, at lowest cost. Vermont bars all cost efficient out-of-state insurers. Thus,same thing will repeat – every year – w/ OneCare and BCBS….fast rising insurance rates & costs far above inflation. OneCare and BCBS have a legislaiver granted “monoply”. They will never, ever be cost effective or efficient (only expensive) – with the ever so tiny population in VT.

Moshe Braner

single-payer or die hard

Vic Noble

GMCB should be impeached!

Karen McIlveen1

Once again politically appointed lay people playing with our money ,our health decisions and our care.
Why isn’t this illegal?

Maryalice Bisbee

Just think of the two or perhaps more levels of bureaucracy and administration, GMCB and One Care, that are financially drowning Vermonters in a huge debt! And yet no one wants to even consider a single payer, Medicare for All plan to help control costs. I doubt that government oversight would pay their administrators anywhere near what this For Profit conglomerate is charging!
Some of the concepts seem logical. But why should health care dollars be spent to provide community support services, housing options, etc. that should come from the Agency of Human Services? Why should a Medicare consumer like me receive a $25 check as a “reward” for being part of an ACO? SASH services are wonderful but should they be paid for by health care dollars? And if we want to improve primary care why are we not paying more for young doctors to move to Vermont? If we want change we must pass a Medicare for All ballot item at March Town Meeting.

Sandy J Rhodes

Carpetbaggers. GMCB and One Care are current day carpetbaggers. Vermont tax dollars are apparently too easy for these types of organizations to acquire. They spend with no regards for transparency or accountability. These people should at the minimum, be bonded against poor performance, failed programs, high cost overruns and losses. Otherwise they waltz in, collect high salaries and after mahem and failure, waltz away with no remorse, no accountability, no bad report card. That’s what carpetbaggers do.

Christian G Behr

The Vermont Government has managed to remake health care in the image of the DMV

Vicki Ward

Until the 1990s in healthcare, we had Community Health Nurses and Public Health workers who practiced what is called Primary Prevention-initiatives to prevent health problems. There is an entire body of knowledge centuries old. Once again, politicians and the medical community with their MBAS, deconstructed much of this work. I worked in both community health and public health! This work was done in the spirit of intelligence and true care, not well compensated. If only we had this budget!
I would not trust this body of work, as it is DRIVEN by GREED, not care and skill .

Richard Clattenburg

GMBC works very hard and is sincerely trying to get it right. But
at no cost they could adopt rules requiring health providers to publish prices
of most frequent medical services — such as office visits, ER visits, and deliveries.
Open pricing would introduce cost competition and make the healthcare market more efficient and
more affordable — without any new computer systems or layers of bureaucracy.
Hospitals will say the pricing is too complex to do this; other industries do not get away with this response.

Chet Greenwood

And to think we had to get rid of private insurance companies because their administrative costs were too high!

Martin Dole

I am in hopes someone is over looking the books better this fiscal year.


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