Vicki Loner: Value-based care better serves our providers and community

This commentary is by Vicki Loner of Hinesburg, CEO of OneCare Vermont.

OneCare Vermont is an organization of health care providers with the shared goal of improving the health of Vermonters while slowing the rate of cost growth. 

These two outcomes are the essence of what we call value-based care. We have demonstrated success by bringing doctors, hospitals and other providers together to coordinate care and to negotiate payment reform terms, rewarding good health outcomes for Vermonters.

Bringing providers together for better care coordination, ultimately, is what has made our accountable care organization a valuable part of Vermont’s health care system. Our overall strategy, including the data and analytics we offer to our 5,000-plus participating providers, is to help better inform and reward providers who prevent or mitigate serious complications from common chronic diseases, such as diabetes and hypertension. In doing so, we are improving Vermonters’ health and reducing the costly treatment of these diseases by preventing their progression.

Changing the complicated ways health care is paid for and delivered has been challenging work. That was true when we first came together, but it has been especially true over the last 18 months of this pandemic. However, we are making progress. 

A recent evaluation by NORC at the University of Chicago, one of the largest independent social research organizations in the United States, found the Vermont all-payer accountable care organization model achieved statistically significant Medicare gross spending reductions at both the accountable care organization and state levels, as well as Medicare net spending reductions at the state level; statistically significant declines in acute care stays at the accountable care organization and state levels; and declines in 30-day readmissions at the state level.

Building on this progress, OneCare submitted our 2022 budget to the Green Mountain Care Board on Oct. 1. Our proposed budget balances the benefit of investment in our system’s transition to value-based care with the costs to our participating hospitals, recognizing the economic hardship this pandemic has brought to our provider partners. 

Now more than ever, we must continue to work together across the state to support the transformation of our health care system. During this pandemic, the fixed, predictable payments called for in value-based care — instead of the traditional fee-for-service setup — have been a lifeline for many participating providers, both large and small. This has helped to build momentum for the critical and necessary work of health care reform.

As OneCare continues to evolve, we evaluate every aspect of our work to provide the most amount of good for Vermonters. Our governance structure ensures OneCare’s board of managers — which includes diverse provider and consumer representation — decides how health care funds are distributed to participating providers. 

Changes in OneCare financial policies — including those that determine how these dollars are distributed — must be approved by a supermajority (14 out of 21 board members). No one provider, including the University of Vermont Health Network, is able to unilaterally make decisions. That is why we have such a broad and inclusive governance model.

Five years from now, if we continue to build trust and confidence, most health care services could be reimbursed based on the value they offer patients. It’s a change brought on by necessity — as costs under fee-for-service outpace our collective ability to afford them — but I believe value-based care better serves our communities and our providers alike. 

It moves us toward a health care system where patients and providers work together to achieve the best health they can. The faster we can move into this world, the better off the people of Vermont — and the health care providers who serve them — will be. Our budget submission reflects these principles and our continued efforts to realize this vision for our state.


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