Sadkin & Asselin: OneCare is a lifesaving measure for independent primary care 

This commentary is by Toby Sadkin, M.D., and Jon W. Asselin, both of Primary Care Health Partners. Sadkin is the organization’s executive committee chair and also physician manager at St. Albans Primary Care, one of its medical offices. Asselin is chief operating officer and chief financial officer for Primary Care Health Partners. 

Without OneCare’s innovative comprehensive payment reform program — aptly called “CPR” — several practices would likely not exist today. 

We have seen considerable discussion regarding Vermont’s health care system and the value of OneCare’s role. On behalf of Primary Care Health Partners, we can confidently say that OneCare has been vital to the survival of independent primary care practices. 

It is widely recognized that stabilizing and expanding primary care is essential to achieving an efficient health care system, and the CPR initiative piloted by OneCare has provided a significant investment toward achieving this crucial objective. 

Primary Care Health Partners has 31,000 active patients in Vermont. We are the largest employer of independent primary care physicians in the state, with offices in northern and southern counties covering adult medicine, family medicine and pediatrics. It is important to note that, as an 

independent group of practitioners, we are not associated with a hospital, nor are we a federally qualified health center. Our revenue consists primarily of fee-for-service payments from insurance carriers and capitated payments received from OneCare. 

Despite limitations in the sources of revenue, independent practices provide high-quality care at a lower cost; in fact, one might argue too low, given the historical challenges in obtaining rate increases from payers. 

Preserving the independent practice model is important in recruiting practitioners to the state who seek professional satisfaction in owning their own practice. However, the lack of adequate reimbursement throughout the years has taken its toll. While perseverance is a key attribute to succeed as an independent, there is a point where many practitioners must surrender, instead opting for the higher compensation and salary guarantees of the other operating models.

Through the years, we have lost several practices for exactly this reason, and prior to the development of OneCare’s CPR program, we would have described our future as dismal at best. 

OneCare’s use of the acronym CPR was fitting. OneCare recognized that independent primary care practices needed lifesaving measures. Had it not been for CPR, it is likely several of our remaining practices would not exist today. Without an adequate revenue stream, we too would need to accept that perseverance alone is not enough to survive. 

We believe OneCare’s CPR program has been one of the greatest innovative care models aimed at preserving independent primary care in the state. We have had the opportunity to stand alongside senior leadership from our state’s hospitals as we discuss transformative ways to expand primary care while reducing hospital utilization. These discussions are collaborative, not adversarial. 

OneCare’s leadership, recognizing the need to stabilize and expand primary care, has been at the forefront in spearheading this effort. 

While OneCare has been an advocate for primary care, that advocacy comes with the understanding of the need for accountability. As stewards of the state’s health care dollars, OneCare has identified the need to evaluate the return on investments. A recent example can be seen in the evolution of the CPR program where payments will be tied to actions taken to support mental health initiatives within the primary care setting. While we all appreciate the critical need to invest in mental health, that investment is being coupled with accountable measures. 

There has been and continues to be a shortage of primary care practitioners across the state, impacting preventive care needed to keep health costs down and Vermonters healthy and well. It is our sincere desire that OneCare continues the ongoing development of the CPR program. We feel it is an essential step toward the stabilization and expansion of primary care in the state, a necessity to realizing better health care for all Vermonters.

Correction: The commentary writers failed to disclose that Toby Sadkin, M.D., is on the OneCare board and Jon W. Asselin has served on its finance committee. VTDigger's commentary guidelines state: "Commentaries must include the author’s first and last name, their town of residence and a brief biography, including affiliations with political parties, lobbying entities or special interest groups."


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