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 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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