Editor’s note: This commentary is by Michael Johnson, MD, who is managing partner at Evergreen Family Health in Williston.
Despite what was implied in recent reports, not all primary care practices in Vermont agreed to remain part of OneCare.
Last Friday, my five partners and I chose to not renew our contract with OneCare. We are each aware that we are putting our own income at risk. Why would we choose to do that at a time already fraught with such uncertainty?
We choose to take this risk based on hope. For over 20 years, our office has been providing top quality primary care at the lowest possible cost to patients. The latest OneCare contract does not reward that efficiency and actually punished us by reducing our payments and promising to reimburse us only if the OneCare hospital system became profitable. Individual office quality and efficiency no longer matter.
I am personally an advocate for single-payer health care, but I am terrified of single-provider health care. In a time of so many crises, it is easy to forget one long-standing crisis: Vermonters and Vermont businesses have been and are still facing a health care affordability crisis. Every day I talk to patients about important medications, tests or referrals that I recommend, but which they can’t afford. Most of my patients, like my own family, are either on high-deductible insurance plans or subject to “donut hole” coverage gaps. This very real problem has been talked about for years but it is worsening rather than improving. I do not see any evidence that further consolidation and monopolization of health care will solve this problem.
The goal of accountable care organizations is to reward quality and cost savings rather than volume of care. However, that goal cannot be achieved by cutting back on primary care or by establishing a monopoly on health care. Easy access to affordable high-quality primary care saves money by avoiding more expensive emergency rooms, specialty care and hospitalizations. By choosing to leave, we may actually help OneCare become more efficient knowing that patients and practitioners have a choice.
Recently I have needed to reassure many supportive patients that we are not going out of business or leaving the state. While leaving OneCare was a very difficult decision, I am now more optimistic that we can remain financially viable in the long term and continue to offer our patients a lower cost, high quality personal primary care option for many years to come.