A Message from OneCare CEO Vicki Loner: OneCare’s Response to the Pandemic

Dear colleagues,

I want to thank you for your incredibly valuable service to Vermonters and communities across the state. Your courage, dedication, and resilience is vital to our collective efforts to flatten the curve and reduce the spread of coronavirus. I cannot emphasize enough the importance of all the frontline workers and volunteers who are resiliently working day and night to keep essential services available during the pandemic.

Since Governor Scott declared a state of emergency in Vermont on March 13, we’ve all undergone significant change in our daily lives. While the social, economic, and individual impacts have been widespread and beyond what many of us have experienced in our lifetimes, I feel privileged to live in this state, where we are more than willing to step up and come together to support each other and our communities.

To support you as you provide valuable health care and services to Vermonters, OneCare is delivering program changes to build stability in the healthcare system and tools to help you care for your patients. We are bringing you critical patient data, advancing needed cash flow, advocating on your behalf at the state and federal levels, and providing increased ease in accessing OneCare’s staff and resources.

COVID-19 Application for Health Care Organizations

Finding and outreaching to patients who are at greatest risk for COVID-19 is a critical preventive healthcare goal during the pandemic. To support providers in this aim, OneCare launched a new care coordination identification tool and care scripts to help network providers identify patients with the greatest COVID-19 virus risk using criteria developed by the WHO, CDC, and Johns Hopkins.

In addition to clinical risk factors, the application surfaces patients who may be at greater risk of illness due to social determinants of health, such as housing and food insecurity. More than ever, Vermonters may be socially isolated, have a higher risk of food or housing insecurity, or be at risk of developing complications, simply because they are unable to access essential services. Outreach by healthcare providers can help keep the most vulnerable Vermonters connected and safe.

The application is designed to help providers outreach to patients with the greatest risk in order to keep these patients safe and out of the hospital. Providers can work with patients to develop emergency plans, help them with prescription needs, identify social needs, and help to support management of their chronic conditions. The application has already been used by 12 of the 13 health service areas in Vermont, including 30 organizations in the OneCare network. Users report the application is useful and simple to navigate.

In the St. Johnsbury health service area, providers are actively using the information generated from the COVID-19 app to create panels for ongoing outreach efforts with patients. The Bennington health service area developed an ongoing process to identify patients each week, and to securely send lists of patients with the greatest risk to care coordinators. Care coordinators then begin outreach to patients, prioritizing the highest risk levels.

Ensuring Cash Flow to Healthcare Organizations

Our healthcare system requires a predictable cash flow to continue operating during the pandemic. We have been aggressively searching for ways to provide financial relief to providers, working closely with the Green Mountain Care Board (GMCB) and our board of managers to propose and approve actions that increase cash flow. These include advancing Care Coordination and Population Health Management payments to primary care practices, home health, designated agencies and area agencies on aging as well as a return of Value Based Incentive Fund payments to hospitals.

Steady, predictable cash flow helps facilitate the ability of organizations to provide necessary services to their communities. The Accountable Care Organization model is designed to do just that: provide healthcare organizations with the funds they need to provide care and improve people’s health. Network organizations have found that fixed payments for hospital and independent primary care provides stability and predictability when there are shifts in care delivery. The steady revenue OneCare provides can position health care organizations for success, and reduce the risk associated with a slowdown in fee-for-service and elective procedures as we stay home to keep ourselves and our communities safe. We are exploring opportunities to increase participation in fixed payment programs to expand this value.

Advocating at the State and Federal Level

During the pandemic, we are working hard to stabilize the health care system while continuing to stay on track with health care reform. Transitioning to a value-based system is an investment in Vermont’s future. OneCare is driving a more consistent care model to provide the best care for all Vermonters. We are pursuing a multi-pronged strategy to support providers and Vermonters during the pandemic.

We are advocating at the federal, state and payer level to reduce administrative burden, increase access to telehealth codes, hold providers harmless for performance and financial related penalties, and identify additional funding and advancement opportunities for all participants. You can read more about our specific efforts in these slides from my recent presentation to the Green Mountain Care Board.

OneCare is also pursuing flexibilities from our payer partners to hold providers harmless from the impact of the pandemic. Key recommendations include strategies on quality reporting, fixed payments to hospitals and independent primary care, and additional funding opportunities. OneCare contributed to a letter that the All Payer Model agreement signers sent to Medicare & Medicaid Innovation (CMMI) asking for specific actions that would support providers participating in the model.

Direct Support to Providers

At our core, OneCare is a community of providers that are working together to improve health, quality, and contain cost growth. We are here – before, during, and after the pandemic – to work with you to achieve that goal. In this critical time, we have improved our accessibility so that you can reach us easily.

We understand the need to gain timely and accurate information to support your organization. Over the past month and based on feedback from our provider communities, we have redesigned our network support model to better meet your needs. We now offer direct access to specific departments with expert teams well-equipped to provide you with the specific ACO supports you may require.

Thank you for your commitment to the health of Vermonters and your communities.

Respectfully,