Editor’s note: This commentary is by Patrick Flood, the former commissioner of the Department of Mental Health and the Department of Disabilities, Aging and Independent Living, and former deputy secretary of the Agency of Human Services. He is now retired and lives in Woodbury.
There is probably very little the progressive Vermont Workers’ Center and the conservative Ethan Allen Institute agree on, but there is one issue they do. Both organizations agree that the state’s current efforts in health care reform, the All Payer Model implemented by OneCare Vermont, are misguided and have failed. Rob Roper of the Ethan Allen Institute recently called it a “debacle.” The Workers Center hosted a virtual public hearing on June 30 that featured two hours of Vermonters describing how our health care system has failed them, which included blunt criticism of the accountable care organization, OneCare Vermont.
Even Richard Slusky, a long-time health care administrator and architect of the All Payer Model, has just written a highly critical commentary in these pages, saying the model and ACO are not succeeding and Vermont needs a change in direction.
This follows closely on the heels of the latest Auditor of Accounts review of the model which clearly shows the OneCare is not saving money for Vermonters but rather costs us all more. The auditor does not evaluate the model’s quality of care, but there are few indicators that care has improved.
This should come as no surprise. Many people have criticized the state’s efforts and OneCare’s performance for years. Even the chair of the Green Mountain Care Board, Kevin Mullin, said the results were “abysmal.” Yet state leaders have blindly insisted on pushing forward a model that is not working.
But there’s more.
The Green Mountain Care Board just released the latest numbers on how many Vermonters are actually covered by the ACO. OneCare, after four years of trying, is 13% below the target agreed to with the federal government for the overall effort and a whopping 32% below the target for the Medicare population. The ACO covers a mere 36% of Vermonters. The state’s response is to move the goalposts by redefining the measures to make it easier for the ACO to achieve the targets. They have also attempted to boost the numbers by requiring the 12,000 members of the state employees’ union to join even though the union opposed it.
And, in an additional failure that few people know about, the data system the ACO built to supposedly improve communication and care, called Care Navigator, has been deemed a failure and the ACO has begun rolling out a new system. After four years, some unknown millions of dollars and untold hours of implementation by providers, OneCare’s care management system is a failure and everyone needs to start over. This is the kind of wasteful incompetence we have come to expect from OneCare and is emblematic of the whole effort.
Meanwhile, the Scott administration has asked the federal government to renew its Medicaid program, called the Global Commitment Medicaid waiver, to allow Vermont Medicaid to be a managed care organization. As such, Medicaid would assume financial risk and be permitted to re-invest any savings. This is exactly what the ACO is supposed to be doing. If we have a state-run managed care organization, why do we also need OneCare, a private one? It is incredibly duplicative, expensive and wasteful.
So why is Vermont stubbornly continuing down this road and seeking to expand the ACO model? Why is the Scott administration so tolerant of gross failure and waste? The ACO model is not serving more people, it is not reducing costs, and it is not expanding access to primary care physicians. It is essentially preserving the status quo. The UVM Health Network just asked for a 7% rate hike. How is that making health care more affordable?
The All Payer Model and the ACO have done nothing in four years to actually help Vermonters in need. Listen to Vermonters tell their stories about what is wrong with our current health care system, spoken at last week’s Vermont Workers Center hearing. Many Vermonters (insured as well as uninsured) are suffering from lack of care, and the All Payer ACO model is doing nothing to help them. In the meantime, the executives at the UVM Health Network and OneCare Vermont continue to pull in salaries in the hundreds of thousands of dollars. Where is the accountability?
In his commentary, Richard Slusky calls for a change in direction and a commission of “stakeholders” to talk frankly about this effort and what needs to be done. Many people would support this idea. But it must include listening to Vermonters, not just vested interests. Vermonters know what is needed; and it is not more expensive, incompetent bureaucracy.
I firmly believe we can achieve real reform. There is plenty of money in Vermont’s health care system (over $6 billion); however, we are spending it in the wrong ways. We do not need to raise taxes. We can reallocate existing funds from what is unnecessary or duplicative to what will actually help. And we can start by reallocating the $16 million a year currently funding OneCare. We can lower costs by making sure everyone has access to affordable primary care, strengthen mental health services, address the non-medical determinants of health like housing and hunger, and increase prevention and early intervention efforts. When we do this, we will reduce the reliance on high-cost services. We can also better regulate expenses in hospitals (our most expensive services) and bring down costs, which the GMCB has shown a reluctance to do.
The state is preparing to ask the federal government for permission to continue this failed experiment. Vermonters must demand we end the experiment and have the public discussion that Richard Slusky calls for. Then hopefully we can begin to actually help Vermonters in need.
