Dozens of primary care practices are likely to receive all or close to all of the accountable care organization funds they anticipated in 2023, two recent developments suggest.
The funds in question that were budgeted to go to primary care practices amount to $4 million to $5 million per year, over and above what they would expect to receive for patient care.
That arrangement was altered when the state’s largest insurer, BlueCross BlueShield of Vermont, announced in late December that it would not contract with OneCare in 2023.
This year, 40 practices employing around 80% of all primary care practitioners are participating in payment programs offered through OneCare Vermont, which is the state’s only “all payer” accountable care organization, or ACO. (“All-payer” means the ACO contracts with Medicare, Medicaid and private health insurers.)
The funds, available through OneCare since 2018, have allowed practices to hire additional support staff to coordinate patient care. For independent practices, which generally operate with thin margins, the money also provides a steady source of cash and greater financial stability. But its availability is tied to contracts between OneCare and patients’ insurers.
BlueCross had previously promised to continue to pay providers directly the same funds they would have received through OneCare until June 30. That timeframe left practice managers nervous about covering salaries for the rest of 2023.
But late last month, the insurer released a public statement committing to the same level of payments that would have flowed through OneCare for the entire calendar year. In 2021, the amount paid out by BlueCross totalled around $2.5 million.
BlueCross and OneCare are in early discussions about what would be needed for the insurer to sign up again for 2024. The insurance company has questioned the ACO’s ability to rein in costs or improve health outcomes for its members. Also, BlueCross is concerned about OneCare’s plan to outsource health data management and analysis this year to its parent company, University of Vermont Health Network.
Meanwhile, all five Green Mountain Care Board members signaled in statements during a March 2 meeting that they expected OneCare to find a method for paying providers the remainder of the funds they would have received, around $1.8 million. Funds OneCare pays that are tied to patients covered by federal insurance programs are flowing as in previous years.
Care board staff presented several ways that the remaining funds, which come from annual dues paid by the state’s hospitals to OneCare, could legally be passed on to primary care providers.
Federal regulations require that payments from an accountable care organization to health care providers be related to health outcomes or care quality measures laid out in contracts with insurers or other public or private payers.
The board wants OneCare to provide a specific plan for full dispersal in its final budgetary submission, which is due at the end of March.
OneCare chief operating officer Sara Barry responded during the public comment portion of the meeting that the organization had already taken concrete steps towards making that happen.
“I think this is a critical issue for Vermonters and certainly for our health care providers and OneCare continues to see itself as part of the solution,” she said.