Vermont leaders say they need more time to rework the state’s health care reform plan.
The state is entering the final year of a five-year agreement with the federal government, enacting what was supposed to be a sweeping shift to value-based care. But health care disruptions from the coronavirus pandemic stymied Vermont’s progress and officials plan to ask for a one-year extension, state officials told the Green Mountain Care Board on Wednesday.
Ena Backus, director of health care reform, stressed during the virtual meeting that the state would use the year to negotiate a five- or six-year agreement with the federal Centers for Medicare and Medicaid Services.
The state’s all-payer model and OneCare Vermont, the accountable care organization that’s become almost synonymous with the model in the public eye, have come under scrutiny for falling short of the original vision.
Under the all-payer model, Vermont’s private and public insurers pay to keep patients healthy, rather than for every service, such as blood tests, checkups or X-rays. If enough patients participate, the thinking goes, the state’s health care would be cheaper and better. The promise of lower payments for better care attracted federal regulators, who in 2016 signed on to that vision in an agreement with the Vermont state government.
Care board Chair Kevin Mullin said Wednesday that health care providers and state officials are working through staffing challenges and tight intensive care capacity brought on by the pandemic, and a one-year extension would give everyone time to reshape the model.
“This is the reality,” he said. “We all hoped that when the pandemic started it wouldn’t have lasted as long as it has.”
The Green Mountain Care Board is expected to endorse the proposal later this month, and negotiations on a new five- or six-year agreement would begin soon after federal officials approved the one-year agreement.
Vermont has consistently fallen short of the targets set in the 2016 agreement. State leaders committed to having 70% of all Vermonters participating in the all-payer model by the end of 2022, but only 57% are enrolled so far, according to Vermont’s most recent report to the Centers for Medicare and Medicaid Services.
These discussions come on the heels of substantial changes in OneCare. John Brumsted, longtime University of Vermont Health Network executive, recently announced he was stepping down from his leadership role on the accountable care organization’s board. Last month, the University of Vermont Health Network became the sole parent organization of OneCare.The nonprofit was originally a joint venture of Dartmouth-Hitchcock Medical Center and UVM Medical Center. Brumsted said the new governance structure was part of an effort to course-correct after the Centers for Medicare and Medicaid Services put the state on notice for missing enrollment benchmarks in 2018 and 2019.