Too Big To Fail?

TOO BIG TO FAIL?
By Richard Davis

Three years ago Vermont started an experiment to try to improve the quality of health care and to lower costs. A for-profit entity called One Care was created and, from the start, the organization’s complexity and lack of transparency has been an issue.

Those problems surfaced in a recent public hearing before the Green Mountain Care Board, the entity that has regulatory control over One Care. One Care is proposing a budget of $1.43 billion. Those funds come from insurers such as Medicare and Medicaid and private insurers and are then funneled directly to hospitals and providers.

Here’s a description of the promise of ACO’s that was in a Vermont Business Magazine story when One Care was first organized. “Nine Vermont communities have chosen to participate in ground-breaking new approaches to health care through partnerships with OneCare Vermont in 2018, according to a provider submission made with both the Centers for Medicare and Medicaid Services (CMS) and the Department of Vermont Health Access (DVHA). Hospitals, independent physician practices, specialists, skilled nursing facilities, designated mental health and substance use agencies, Federally Qualified Health Centers (FQHCs), home health providers and area agencies on aging are among those who are participating in population health programs in the coming year. Under this model, participants are moving away from fee-for-service medicine that rewards volume and instead embracing a system that rewards providers for keeping people healthy. With providers being paid differently, there will be increased support for providers to engage with patients to improve quality and patient experience.”

As described in a 2017 Vt Digger piece, “It (One Care) is a health reform company partly owned by the UVM Medical Center that will soon coordinate insurance money and patient care across a large and diverse group of health care providers in the state.”

One Care plans to have almost all of Vermont’s patient population within its system by 2022 and that means that most of our health care dollars will pass through this organization. Do we really need another layer of bureaucracy to administer health care through a non-system that is already bureaucratically top heavy?
After doing research over the years and then trying to figure out where I personally stand with One Care as a Medicare subscriber, I contacted my local primary care doctor’s office and was told that I need a special form to disenroll from One Care.

When One Care started they sent letters to Medicare recipients whose doctors had become part of One Care and told patients they were automatically enrolled unless they submitted a form telling their insurer they wanted out. If a provider enrolls in One Care that provider’s patients will become One Care members unless they opt out. When I searched the One Care web site it looked like an advertisement for a better life in Vermont but nowhere did it explain how you become a member or how you disenroll.

I contacted One Care and they told me to contact Medicare directly if I want enrollment information. One Care has some benefits that include many supportive services that would be available whether or not a person is a member. One big advantage of One Care is that if you are a member there is a federal waiver so you don’t have to spend three days as a hospital inpatient before Medicare pays for rehab at a rehab facility.

No matter what insurance you have you should contact your local medical provider and ask them if you are a One Care member. Do some research, look up recent news stories about One Care and decide if you want to be part of an organization that is being criticized by the state’s health care ombudsman, the state auditor and others for mismanagement and lack of transparency. One Care will not publicly reveal salaries of top executives, yet they are using taxpayers’ health care dollars to run their organization.

A November 3 VT Digger story referring to Vermont health care advocate Mike Fisher noted that, “He also asked OneCare to define “affordability” and how it plans to achieve it for Vermonters. OneCare’s answer was obtuse. “OneCare is working as a vehicle to support the goals under the ACO-APM that was signed by the State of Vermont and CMS,” the organization wrote in written responses to Fisher. Some questions were not answered at all. Other responses were wholly unsatisfactory, Fisher told VTDigger in an interview. “We were frustrated or disappointed with a lack of detail in their answer to us,” he said of OneCare’s responses. “We’re trying to figure out how to get better answers from them.”