One of the initiatives to come out of the Gov. Peter Shumlin administration was a dramatic overhaul of the state’s health care payment system, now known as OneCare. But’s its struggling to move forward, and one well-known critic says the system is overrun by bureaucracy and a lack of transparency.
In an effort to make health care more affordable, Vermont backed a private company’s mission to create a new system that pays health care providers in monthly payments using a mix of funds from Medicaid, Medicare and private insurance companies. The idea has been to focus on quality of care overall, not payments based on individual services offered to patients — the traditional fee-for-service model.
The way OneCare works is health care costs are paid for in block payments rather than when individuals get care at a doctor’s office or hospital. The system adds another layer of bureaucracy to the health care system as the health insurance companies pay the block payments to the health care providers.
But the main problem facing OneCare is that people aren’t signing up. To date, just about 42 percent of all eligible Vermonters have signed up — far short of the 60 percent goal for this year. But the system needs most of the state’s population to sign up to succeed; The goal is to have OneCare cover about 70% of Vermonters by the end of 2022.
Louis Meyers, a doctor at Rutland Regional Medical Center, says the OneCare system is plagued by big bureaucracy.
“Well, I think that it’s a huge top-down administrative program that is run from the University of Vermont. I think it sort of takes over,” he said. “It forces practices and hospitals to march to the University of Vermont and OneCare’s drummer.
“It’s very time-consuming and expensive for the hospitals to meet some of the requirements that OneCare has to get that money. I mean you have to provide them just tremendous amounts of data, which usually means you have to hire extra staff.”
Another problem, Myers says, is a failure to allow for transparency.
“They’ve been very secretive and they haven’t been very transparent about how OneCare is spending the money,” he said. “They haven’t been transparent about their cost overruns, which are really increasing — they’re huge. I mean, they are spending a lot of our taxpayer money, much more than was targeted.”
“The all-payer ACO model is costing Vermonters about $20 million in bureaucratic costs and we are not seeing the benefits,” outgoing Lt. Gov. David Zuckerman said at an October press conference in which he addressed health care issues during his run for governor.
Meyers says that OneCare is getting to be a more attractive offer now that there is some new urgency to get people signed up.
“It can be very risky, too, because although they are waving some of the risks this year for OneCare in general, if you don’t meet the benchmarks they can claw back a lot of money, [which] basically penalizes practices and hospitals for not meeting various benchmarks in terms of their cost and the quality,” he said.
OneCare gets a waiver from the government to use Medicare, which is incorporated into the program as hospitals and individuals sign up. However, the federal Centers for Medicare & Medicaid Services sent a letter to the state in September that warned about it being way behind on its targets.
Gov. Phil Scott has said the system has seen some success, primarily in reducing the amount of money spent on health care services by $7.7 million. Human Services Secretary Michael Smith, another proponent of OneCare, recently reiterated his support for “trying to make this successful.
One solution the governor has proposed is forcing Vermont’s 19,000 state employees — including retirees and family members — in to the OneCare system.
Meg Hansen, former director of Vermonters for Healthcare Freedom, told True North she doesn’t think that’s enough to save the system.
“Vermont’s push to add state employees to OneCare is a Hail Mary plan to salvage yet another failed health care experiment,” she said.
Earlier this year, Hansen wrote that “Vermont’s All-Payer model, run by a for-profit company called OneCare Vermont, has worsened access and the quality of health care, while any benefit to the people of Vermont is yet to be demonstrated.”