Updated at 5:41 p.m.
Blue Cross and Blue Shield of Vermont, the state’s largest health insurer, announced Tuesday that it will not contract with OneCare Vermont in 2023, effectively putting the brakes on its participation in the state’s “all-payer” reform program for now.
The nonprofit health insurer has been negotiating next year’s agreement with OneCare, the only active “all-payer” accountable care organization in Vermont, for months, said Sara Teachout, Blue Cross’ director of government and media relations. After failing to come to terms about legal guardrails around the use of the insurer’s claims data, Blue Cross made the decision to step away for at least a year, she said.
As part of their work together, “we give them a lot of very detailed data about our members’ claims,” Teachout said. “We need to be able to protect our individual members’ privacy.”
Accountable care organizations, or ACOs, which are private groups of affiliated health care providers, play a key role in Vermont’s current health care reform strategy. OneCare, a non-profit that is part of the UVM Health Network, contracts to bundle outcome-based payments and incentives from multiple sources — Medicare, Medicaid and private insurers — and deliver them to providers.
OneCare CEO Vicki Loner said her company only learned on Monday about Blue Cross’ decision, which she called “very shocking to us,” especially so close to the new contract term starting January 1.
The withdrawal of Blue Cross cuts the number of Vermonters enrolled in OneCare’s portfolio by around 93,000 people, roughly one-third of its total, and brings the amount of health care spending under contract with the ACO down by the same percentage, according to estimates for 2023 by the Green Mountain Care Board.
OneCare’s payer contracts are currently renegotiated every year. “It’s a lot of work, and the timing is always really tight,” Loner said.
Loner said she expects the company’s board of managers to close soon on contracts with the state Department of Vermont Health Access for Medicaid and with MVP Health, the state’s next largest health insurer. OneCare staff are still in discussions with the U.S. Centers for Medicare and Medicaid Services about the company’s contract with Medicare.
With Blue Cross, “we were open to still staying at the table, but then I see this press release,” Loner said. “It’s an odd way to manage your negotiations, if you’re still really trying to negotiate.”
But without an agreement on protections around the claims data, Blue Cross did not see how it could continue to effectively work with OneCare, said Teachout. “That is one of the building blocks of this program, using data to improve outcomes and care,” she said.
In general, Blue Cross is not seeing evidence among their members participating with OneCare of progress on health outcomes or cost of care, Teachout said. But the insurer’s more immediate concerns stem from a plan OneCare unveiled in August to start outsourcing its health care data management and analytics to UVM Health Network next year, she said.
Part of OneCare’s work with participating hospitals and other providers involves producing regular reports of outcomes and trends among patient groups. OneCare staff told state regulators at the Green Mountain Care Board during a budget presentation in November that its current data analytics system is not as effective as software that UVM Health Network is starting to use, and that the ACO could access the platform more inexpensively by subcontracting the work.
“Us doing this alone would cost Vermonters more money, and we would have had dueling data analytics with our largest healthcare provider and our sole member organization,” Loner told the Green Mountain Care Board then, referring to the UVM Health Network.
OneCare plans for all its information to be kept in separate secure physical or cloud-based storage, and for only staff working on OneCare activities to access it, staff told the Green Mountain Care Board at the time.
But Blue Cross does not feel its current contracts with OneCare have sufficient legal protection about how the insurer’s claims data could be accessed or used by UVM Health Network staff, Teachout said. Along with considerations about member privacy, independent practitioners may not want that information accessible outside of OneCare.
Blue Cross is also concerned because UVM Health Network now offers a Medicare Advantage health plan in conjunction with MVP Health, a direct competitor.
From her perspective, Loner said, Blue Cross did not give OneCare an opportunity to respond to their concerns. “We’ve continued to say that if there are unanswered questions that you have, they are resolvable,” she said.
Blue Cross still supports the reform effort’s goals, to improve healthcare quality and rein in costs by changing how health care is delivered and paid for, Teachout said. Blue Cross intends to continue monthly payments to primary care providers and others who provide care coordination services for its members, and to develop other ways to reward them for improvements in members’ health, she said.
The insurer will continue to work with the state Agency of Human Services, regulators and health care providers. “We fully intend to participate and we support their work,” Teachout said.
