The Green Mountain Care Board isn’t expected to vote on OneCare Vermont’s 2022 budget proposal until later this week, but members of the state regulatory board have a lot of questions about the organization’s priorities.
OneCare funnels more than a billion of the state’s health care dollars to hospitals and other health care providers in Vermont. The nonprofit organization is part of a statewide effort to shift the way insurers pay for health care — that is, to pay providers a flat fee to keep patients healthy, rather than paying for every blood test, doctor’s appointment or hospital visit.
OneCare leaders say pressures from the Covid-19 pandemic have made it harder to fund oversight activities and investments in community programs that make Vermonters healthier.
“In this pandemic period, which makes value-based care more challenging than it ordinarily is, sustaining what we already have, I think, is a great success to this budget,” said Tom Borys, OneCare’s vice president of finance.
OneCare, which is under the University of Vermont Health Network umbrella, plans to oversee about $1.3 billion of the state’s health costs in 2022 — roughly the same amount as last year. The organization’s proposed operating budget for the next year remains roughly the same, at $15.3 million.
However, the nonprofit organization has consistently fallen short of its enrollment targets. 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 a recent Green Mountain Care Board report.
OneCare officials plan to keep the number of Vermonters who participate roughly the same — about 188,000 enrollees. It proposes covering a roughly $4 million shortfall largely by raising hospital dues by $3.6 million to $18.6 million. It also plans to eliminate an oversight job and cut contributions to Rise VT, whose grants support dozens of health initiatives across the state.
The board received OneCare’s budget proposal on Nov. 10, and staff members have been analyzing it. Board members comment on pending matters only during formal board meetings, so the initial comments made in November are the most current barometer of their concerns.
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 under the model that includes OneCare. The state is seeking a one-year extension with the feds, with the goal of negotiating a longer agreement at a later date.
“We’re in year four and I worry that there’s not enough evaluation happening to make sure that these (health care) dollars are going in the right direction,” board member Jessica Holmes said at the Nov. 10 hearing.
The final vote is scheduled for Wednesday.
OneCare recently has gone through substantial changes. John Brumsted, the longtime University of Vermont Health Network chief executive, 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 U.S. Centers for Medicare and Medicaid Services put the state on notice for missing enrollment benchmarks in 2018 and 2019.
