This commentary is by Ashley Miller, M.D., from the South Royalton Health Center.
I became a pediatrician to provide the best possible medical care to children. Historically, as a physician at a small, independently owned practice, it was frustrating to have to focus a large portion of my time on administrative concerns.
One of the largest of these administrative concerns as a small business owner was whether we would have the funds each month to consistently provide the highest level of care. Individual practices also have had to spend an inordinate amount of time and resources just to collect the payments that are due from insurance companies.
The majority of the payments we receive for the care we provide goes to hiring and keeping excellent staff by paying a competitive wage.
These frustrations changed when OneCare Vermont began making consistent monthly payments to primary care practices, including ours. We were, for the first time, able to focus on providing excellent care to help our patients thrive, knowing the funds to support that care would consistently be there.
BlueCross BlueShield’s recent decision not to contract with OneCare is devastating, as these payments will be reduced and potentially ended altogether. This will once again take our attention and focus away from children and their long-term health.
Joining OneCare Vermont was a game changer for our small, independently owned practice in South Royalton. Instead of wondering if insurance company payments would come in to cover payroll, OneCare’s reliable monthly payments allowed us to focus on improving our patients’ quality of care.
We hired an additional front desk person, which allowed us to improve many aspects of our whole-child health strategy. We could dedicate time to reaching our patients who hadn’t come in for preventive care or childhood immunizations, increase our services to neighboring schools and consider hiring another much-needed mental health professional, and even a nutritionist.
It was such a relief to be able to provide the care our patients needed without worrying and devoting our time and energy to whether we would be able to keep our doors open and meet their needs in six months.
Another issue with BlueCross BlueShield stepping away from OneCare is that they have communicated to the press that they will not be renewing their contract with OneCare; however, they have not communicated this decision to us. This means we do not know how payments will change this year so we have had to institute a hiring freeze, hold off on any raises and suspend overtime while we wait to see what payments we can expect from them.
This makes it more difficult to hold on to good staff who provide the best care for our patients, and prevents us from expanding services to better provide whole health care.
Regardless of how BlueCross BlueShield moves forward with its payments to primary care providers, we know that these payments will not be as full or as reliable as they would be if done through OneCare. We know that the progress on delivering higher quality care that OneCare helped facilitate will be partially erased as we revert to a system where we wait to see what and when insurance companies will pay us.
I am better able to care for the children in my practice when I can focus on keeping their minds and bodies healthy as opposed to simply treating them when they are sick or in crisis. This ability had been made a reality because of the services, care coordination, and consistent monthly payments that OneCare provides.
I know many Vermonters aren’t sure what OneCare is or how it operates, which can sometimes result in skepticism around a new program, but for those of us who do this work day in and day out, the progress being made is obvious.
And as someone who has seen the benefits of OneCare’s work firsthand, there is no denying that BlueCross BlueShield’s decision to abandon Vermont’s health care reform efforts will be a major setback for providers and patients alike.