OneCare Vermont is taking issue with criticisms by the Green Mountain Care Board and others, and has laid down the gauntlet in defiance: it is threatening to quit unless it gets its money.

In a Dec. 16 memo to GMCB, OneCare’s board of directors wrote:

The GMCB is contemplating putting OneCare at risk for approximately $9.5 million in payments to primary care providers and sites that participate in the Blueprint and SASH programs. While the payments are obligated to be paid in full by the GMCB, the revenue stream to fund these payments is dependent on participating providers earning sufficient shared savings. As previously stated, in writing and during public comment, OneCare is not a full risk-bearing entity and we do not carry reserves like [this] one. This order, if approved, would result in OneCare assuming more risk than it can afford. Taking on more risk than we could repay would be fiscally irresponsible for the organization and its provider network.

The premise behind OneCare Vermont is that an accountable care organization (ACO) will collect payments from the federal government and distribute them to health care providers to improve health outcomes.

Critics of the program, including Vermont Auditor Doug Hoffer, have raised alarms about excessive costs, declining fiscal health of small hospitals, inflated salaries for OneCare executives, increased waits for care and more preventable deaths — poorer outcomes for which OneCare Vermont has demonstrated no accountability.

Recently, the Green Mountain Care Board complained that OneCare has simply failed to produce the accounting and other data to measure its success at achieving its stated goals, despite specific GMCB requests for that information.

GMCB took the unprecedented step of recommending a cut to OneCare Vermont’s budget. The entity is being considered for a one- or two-year extension of its contract to achieve its mission, and Vermont is investing an additional $5 million in FY 2023 to hire consultants to gather yet more data to help it achieve those goals.

The GMCB also proposes to restrict payments until OneCare Vermont gets its fiscal act together and demonstrates some accountability.

But the OneCare board that has refused to produce measures of fiscal progress now complains it would be fiscally irresponsible for it to be the bankroll manager for its operations. Rather than risk managing potentially insufficient cash flows to meet its promised goals, its board threatens to simply close up shop, and take federal subsidies with it:

We will not take this decision lightly as it would be a significant blow to healthcare reform efforts in Vermont, and particularly to primary care providers. The Vermont Medicare ACO Initiative sustains many payments and benefits, which could be eliminated if OneCare does not participate in the Medicare model.

OneCare’s Board lists the consequences at stake for Vermont’s health care:

• $9.5M in Blueprint/SASH funding, which is only available if there is an ACO willing to participate;
• $4.0M in Population Health Management base payments to primary care practices and other continuum of care providers;
• $815,000 in Population Health Management bonus potential paid to primary care and other continuum of care providers;
• More than $900,000 in payments to independent primary care practices participating in the Comprehensive Payment Reform (CPR) program;
• More than $2.7 million in Medicare Quality Payment Program bonuses for participation in an Advanced Alternative Payment Model;
• Administrative relief from federal reporting requirements for Vermont health care providers;

At the end of the list the board references the greatest cost: “Approximately $262M of healthcare provider payments reverting to fee for service from fixed payments.”

OneCare’s allegedly overpaid board then cryptically cautions its GMCB overseer to reconsider fiscal constraints: “We urge the GMCB to thoughtfully reconsider your proposed actions on these matters.”

Whistleblower Robert Hoffman delivered a strident email to the GMCB on Dec. 19, in which he called on Owen Foster and the GMCB to stand up to OneCare Vermont’s effort.

As predicted last week — I warned we were headed towards a Too Big to Fail inflection point,” Hoffman wrote. “None of us are surprised this morning to see OneCare VT has chosen its nuclear option in its Too Big to Fail capacity.

“Like Goldman Sachs and Merrill Lynch and all the other banks in 2008, this profligate … organization is willing to burn the system down unless the government gives it exactly what it wants. … This is an inflection point for VT and Gov. Scott and will be precedent setting. Do we negotiate with hostage takers?”

Hoffman lists several powerful countermeasures the GMCB could employ to stand up to OneCare to demand greater transparency and accountability, one of which is to coordinate with Blue Cross Blue Shield (BCBS) for disbursements. Stunningly, BCBS has now announced it will not work with OneCare Vermont for the time being, citing “a lack of visible progress on either health care quality or cost.”

Hoffman has raised alarms for years that OneCare Vermont was favoring executive pay and administrative inefficiencies over transparency and patient care accountability. He claims the current dispute between OneCare Vermont and GMCB is a critical point in Vermont’s healthcare system, ending his email: “This has now become a game of chicken. Let’s see if Chair Foster flinches.”

John Klar is an attorney and farmer residing in Brookfield. © Copyright True North Reports 2022. All rights reserved.