OneCare Vermont this week got Green Mountain Care’s board approval for its 2022 budget, but has been tasked by the board to raise the financial stakes for hospitals. The $ 15.3 million operating budget will allow OneCare to oversee $ 1.3 billion in state health care costs next year.
In its unanimous budget vote on Wednesday, the Vermont healthcare regulatory board also called on OneCare to benchmark itself against other responsible care organizations across the country. Earlier in the week, OneCare CEO Vicki Loner rebuffed the idea, writing in a letter to the board that such comparisons “should not be led by a regulator.”
Kevin Mullin, who heads the board of directors of Green Mountain Care, disagrees.
“We are not trying to micromanage them,” he said in an interview after Wednesday’s vote. “We’re just trying to make sure that any lessons that can be learned by successful ACOs across the country are learned and that they’re on the right track. “
OneCare is part of a statewide effort to change the way insurers pay for health care – paying providers a flat fee to keep patients healthy, rather than paying for each service, like blood tests, doctor’s appointments and hospital visits.
In the all-payer model, hospitals share all savings, but are also required to absorb the financial losses of care.
The board of directors enabled OneCare to ease the financial risk for hospitals during the uncertain first months of the coronavirus pandemic. Incentives and penalties remained low throughout 2021, and OneCare executives wanted it to be that way in 2022.
On Wednesday, however, the board voted to increase risk / reward investments to pre-pandemic levels.
In his Dec. 20 letter to the board, Loner warned that this could “destabilize the OneCare reform agenda” and create mistrust that may cause some providers to abandon the all payers model. But Mullin said low risk / reward investments are not enough to drive significant change in Vermont’s healthcare system.
The board asked OneCare to increase those investments to $ 2.2 million in 2022, from the $ 1.5 million OneCare had offered.
The board also authorized OneCare to increase hospital dues by $ 3.6 million, to $ 18.6 million, next year.
OneCare’s board-approved operating budget of $ 15.3 million, which was shaped by roughly three months of watchdog hearings, will be roughly the same as in 2021. The organization will cover about 188,000 people in 2022, roughly the same as this year.
OneCare, which is under the umbrella of the University of Vermont Health Network, has consistently fallen short of its enrollment targets. The plan was to have 70% of all Vermonters participating in the all payers model by the end of 2022, but only 57% are enrolled so far, according to a recent report from the Green Mountain Care Board.
OneCare has recently undergone substantial changes. John Brumsted, longtime CEO of the University of Vermont Health Network, has announced he is stepping down as chairman of the responsible care organization’s board. Last month, the UVM Health Network became the sole parent organization of OneCare; it was a joint venture of Dartmouth-Hitchcock Medical Center and UVM Medical Center.
Brumsted said the new governance structure is part of an effort to turn things around after the U.S. Centers for Medicare and Medicaid Services warned the state of missing registration benchmarks in 2018 and 2019.
Vermont is entering the final year of a five-year, all-payer model with the federal government, enacting what was supposed to be a radical shift to value-based care. The state is now asking for a one-year extension of the federal deal, hoping to negotiate a longer deal at a later date.
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