The extent of the Green Mountain Care Board’s ability to regulate the state’s only “all-payer” accountable care organization may end up being decided in court.
OneCare Vermont on Friday filed a brief notice with the Vermont Supreme Court stating that the organization plans to appeal an order by the Green Mountain Care Board that, among other findings, required the accountable care organization to reduce executive salaries for 2023. The full motion to appeal is not due to the court for another 30 days.
The order in question was a revision to the regulators’ approval of OneCare’s 2023 budget, originally decided last December. The late-breaking decision by BlueCross BlueShield of Vermont that month not to contract with OneCare in 2023 led the board to determine it needed to approve a revised budget reflecting that and other changes.
After a lengthy review following a divided vote in June, the board released its final written revised order on August 9. Among other requirements, the order said that OneCare executive pay in aggregate must be no higher than what it would be if all executives were paid at the 50th percentile of the comparison group the organization uses to set salaries.
The OneCare governing board’s decision to appeal was due to concerns over how deep into the details of operations that the order goes, rather than the specific requirements, according to organization spokeswoman Amy Bodette.
“This is a slippery slope. We have to take a stand,” she said. “At some point, our board has to be able to run the organization, not the regulatory body.”
The Green Mountain Care Board declined to comment on the notice of appeal.
Bodette said the organization will continue to try to resolve its concerns outside of court, sharing a written statement from interim CEO Abe Berman.
“It is in the best interest of Vermonters to collaboratively resolve these issues,” he wrote. “Our mission is to make the health care system work better for our communities.”
The board and OneCare have also disagreed about the extent to which review of executive salary benchmarking practice should be part of regulators’ budget review this fall for 2024, leading the care board to subpoena more information in July. The fiscal year for the ACO, which is part of the University of Vermont Health Network, is the calendar year.
As the state’s only “all-payer” accountable care organization — one that contracts with federal Medicaid and state Medicare along with private insurers to provide healthcare services for specific groups of patients — OneCare Vermont has played a central role in policymakers’ seven-year effort to change how healthcare providers are paid. The goal has been to shift payment away from a specific fee for a specific service and towards payment based on outcomes and the quality of care.
That central role is expected to continue through at least 2024 as the state has accepted an offer by the federal Centers for Medicare and Medicaid Services to extend the all-payer contract for a seventh, and potentially final, year.
What will happen in 2025 and beyond remains the subject of ongoing discussions and negotiations between the state and federal government as the federal agency seeks to bring several different state-level payment reform models under one program, Pat Jones, the interim director of Health Care Reform for the state Agency of Human Services, told the care board in August.
