Green Mountain Care Board members approved the budget of Vermont’s only active “all-payer” accountable care organization on Wednesday, but reduced its administrative component by 2%. That amounts to just over $300,000, bringing the total down to $14.9 million.
For some members, the cut was clearly a way to show their unhappiness with OneCare Vermont’s apparent lack of progress toward achieving tangible results. The accountable care organization, or ACO, plays a key role in Vermont’s current health care reform strategy.
“I think Vermonters are looking for whether or not we are getting a return for what we are working for,” said board chair Owen Foster. Considering all the information presented, “I do not find that fiscal responsibility has been achieved, and I do not find that this budget as submitted has been fully justified,” he said.
For others, the cut was more an acknowledgement that the ACO’s budget would soon have to be revised downward anyway, since the state’s largest health insurer announced Tuesday it will not enroll members with OneCare in 2023.
“Could I support a modest reduction in operating expenses?” asked Jessica Holmes, a board member since 2016. “Yes, probably, but largely because I believe … that there’ll be a reduction in administrative costs associated with the withdrawal of Blue Cross Blue Shield.”
Accountable care organizations are private groups of affiliated health care providers that contract with private insurers and the federal or state government to provide care to a specific group of patients. Blue Cross and Blue Shield of Vermont was the largest private insurer participating, giving OneCare roughly one-third of its business.
The board required OneCare to submit a revision to its budget reflecting that change by the end of next month. The budget approval also required OneCare to provide a return-on-investment analysis for money spent on the effort between 2018 and 2022, and to submit a report comparing its performance to other ACOs.
The board also specified that OneCare should begin using its own reserves to back the $9.5 million that Medicare will be providing through the ACO to several of the state’s priority health programs in 2023. If OneCare hospitals and providers, as a group, exceed their Medicare spending threshold by more than 3%, those funds would be due back to the federal government. In the past, the organization’s provider network was fully responsible for giving back these funds, though a return has as yet not been required.
While the budget was unanimously approved, the cuts went through in a vote of 4-1, with Robin Lunge, a board member since 2014, in opposition.
Lunge said that while she agrees that changes must be made to some of OneCare’s processes, those improvements are already underway. Also, the organization’s challenges must be seen in the context of the global Covid-19 pandemic and the current “workforce challenges and other pandemic-related aftershocks,” she said.
“I can’t emphasize enough, for myself, how the pandemic has disrupted this program,” Lunge said. “I’m not ready, at this point, to say that there has been fiscal irresponsibility, and so that’s why I can’t support a 2% cut,” although she said that she also expects a reduction in the operating budget if Blue Cross really does not contract with OneCare for 2023.
Asked at his weekly press conference Tuesday about the insurer’s departure, Gov. Phil Scott said the administration planned to get involved in the negotiations between Blue Cross and OneCare.
“We think having Blue Cross Blue Shield and OneCare come together here is important, and we’ll be moving towards encouraging that,” Scott said.
State employees are insured by Blue Cross, and since 2021, those who don’t opt out are enrolled in OneCare through that contract — even though the state employees union balked at the idea in 2019.
Dave Bellini, a retired state employee and former president of the Vermont State Employees’ Association, made a point to thank the members of the Green Mountain Care Board in public comments Wednesday.
“All of you are asking tough questions, and I think it’s a new day,” Bellini said, adding that he represents an “ordinary Vermonter.”
“I can give you a perspective of someone who was at the hospital this morning, someone who has an aged parent,” Bellini said. “I don’t know what the metrics are for OneCare. I mean, it’s hard to understand what they do, other than some monstrous process that they’re proud of.”
But “if you can’t see it on the ground, if Vermonters aren’t experiencing better health care, better access, lower costs, I don’t think it’s working,” Bellini said. “There’s an old expression: ‘the dog won’t hunt.’ So I’ll just leave it at that.”
