Key takeaways from this announcement:
- Dartmouth Hitchock-Health (DH-H) and University of Vermont Health Network (UVMHN) founded OneCare in 2012, with UVMHN providing operational support and DH-H providing accountable care organization (ACO) expertise to get OneCare up and running. OneCare has evolved and become an established ACO for the state of Vermont and so it makes sense for DH-H to step away as a parent organization. However, D-HH will continue to fully participate in OneCare programs as a provider member and will have a seat on the OneCare board of managers.
- UVMHN will now be the sole parent organization of OneCare Vermont, continuing to provide operational support as they always have—like sharing human resources, information technology, and payroll services. To be clear, UVMHN will not absorb OneCare’s data services nor our accounting. OneCare and UVMHN will, however, look for other opportunities to share positions and services that will create more efficiencies and be mutually beneficial in the shared mission to expand value-based care, meaning more dollars can go directly to health care rather than business operations.
- OneCare will remain an independent federal 501(c)(3) with its own governance structure and board of managers. The decision to move to a sole parent organization was made by OneCare’s board of managers, which represents providers and consumers, and is a natural outgrowth of OneCare’s strategic planning process. Along with this governance change, OneCare’s strategic plan gives us the stability and focus to continue our work supporting providers as they transition to value-based care.
- UVMHN’s position as a sole parent in no way causes a conflict of interest or reduces transparency in OneCare’s work. All decisions about how health care dollars are distributed are made by the OneCare Board of Managers, which represents a broad cross section of providers and consumers, rather than by the parent organization. Changes to OneCare policies – including those that determine how these dollars are distributed—must be by majority (11 out of 21 board members) or supermajority (14 out of 21 board members). UVMHN has four seats on the Board. No single provider – even the University of Vermont Health Network—has the ability to exercise outsized or improper influence over its role in the model. And OneCare continues to be regulated by the Green Mountain Care Board, which closely oversees our work.
Colchester, Vt. – Dartmouth-Hitchcock Health (D-HH), OneCare Vermont and the University of Vermont Health Network (UVMHN) today announced a governance change that will make the UVMHN the sole parent organization for OneCare’s work moving forward.
OneCare, a Vermont-based statewide accountable care organization (ACO), will remain its own legal entity and will maintain a governance board that includes managers from throughout the state that represent the full continuum of care and consumers. OneCare will continue its groundbreaking work to improve the health of Vermonters, aligning with its designation this past May as a not-for-profit organization by the IRS. The designation was a strong endorsement of the value of OneCare’s provider-focused work and more accurately reflects the way OneCare does business — a mission-driven organization focused on improving health outcomes and reducing health care spending for Vermonters, accountable to its membership and the people served, and governed with strategic leadership and transparency.
The governance change will not impact OneCare’s statewide provider membership. D-HH will continue to fully participate in OneCare programs as a provider member and will have a seat on the OneCare Board of Managers, signaling its continued commitment to value-based care in Vermont. Steve LeBlanc, D-HH Chief Strategy Officer, said D-HH’s commitment to health care reform in Vermont remains as strong as ever. “Dartmouth-Hitchcock Health is dedicated to remaining in OneCare, and to improving the health of Vermonters through both prevention and the provision of high quality, cost effective care.”
The University of Vermont Medical Center and D-HH joined together to form OneCare Vermont in 2012 and provided the initial start-up investments for the organization. According to John R. Brumsted, MD, President and Chief Executive Officer of UVMHN, UVMHN has the infrastructure to support and sustain the ACO. D-HH has its own separate ACO infrastructure for value based arrangements in which it is engaged in New Hampshire. As parent organization and subsidiary, UVMHN and OneCare will continue to align processes and share resources.
Dr. Brumsted described the governance change as “part of a multi-year, thoughtful effort to better focus OneCare on its core capabilities and achieve efficiencies where possible.” Brumsted also noted that OneCare has already achieved its early mission. “In 2012, we established OneCare as an essential mechanism to pursue value-based contracts that empower providers to deliver higher-quality, lower-cost care. We have a strong foundation to continue to spread value-based care with our partners at the community, state, and federal level.”
OneCare has a membership of 4,840 providers serving every area of Vermont including primary care and specialty physicians, hospitals, home health agencies, and designated mental health agencies that work together across organizational lines. OneCare contracts on behalf of its members to receive “value-based payments,” which reward higher-quality, lower-cost care, a strategy that gives providers the power and flexibility to focus as much on keeping patients healthy as on treating them when they are ill. OneCare provides value through network performance management, data and analytics and payment reform.
“Health care is evolving, and so is OneCare,” said Vicki Loner, RN, OneCare’s CEO. “As the federal government continues to deepen its commitment to value-based care, OneCare will continue to partner with providers who are ready and willing to make that shift.”
The Centers for Medicare and Medicaid Services (CMS) recently released a positive evaluation and summary findings of the APM’s first two performance years (2018 and 2019). “This is the first fully informed, research-based analysis of our work and it shows that our progress has been promising,” Loner said To date, OneCare has entered into value-based contracts with the Vermont Medicaid program, the Medicare program (through the state’s all-payer model, or APM), and two commercial insurers. These arrangements have produced or maintained successes for Vermonters, including:
- Vermont continues to be the lowest cost state in the nation for Medicare.
- Since implementing fixed prospective payments in the Medicaid program, Vermont’s Medicaid budget has grown at an average of 1.45%, compared to an annual average of 5.23% in the previous five years.
- The APM achieved statistically significant Medicare gross spending reductions at both the ACO and state levels, as well as Medicare net spending reductions at the state level.
- There were statistically significant declines in acute care stays (at the ACO and state levels) and in 30-day readmissions at the state level.
OneCare Vermont has evolved since its inception and finalized a strategic plan in June 2021 to ground the organization in where it is today and where it is heading. “Through the strategic planning process, the Board took a hard look at how OneCare can add stability to health care reform and found that a sole parent organization gives OneCare the most stability and creates efficiencies,” says Tom Dee, President and CEO, Southwestern Vermont Health Care. “Because OneCare is an accountable care organization, it has the structure we need to improve quality across hospitals and to work together to achieve our shared goal: better health for Vermonters at a more reasonable cost.”
OneCare’s Board of Managers unanimously voted to accept this governance change. Michael Costa, CEO, Northern Counties Health Care and OneCare Board Manager, highlighted OneCare’s important role in health care reform in Vermont. “OneCare is the primary mechanism for bringing organizations together to engage in health care innovation,” Costa said. “Improving the health and well-being of Vermonters and Vermont’s communities will continue to be the core purpose of OneCare’s network. Our network, comprised of organizations that care for Vermonters every single day, will continue to work collaboratively to reform and improve Vermont’s health system.”
Alida Duncan, Marketing & Communications Manager, OneCare Vermont
Audra Burns, Media Relations Manager, Dartmouth Hitchcock-Health
Annie Mackin, Communications Director, University of Vermont Medical Center
About OneCare Vermont:
OneCare partners with health care providers to transform the health care system to one that focuses on health goals and fosters better outcomes for all. By giving health care providers actionable data and analytics, paying for health care value, and managing ACO network performance, OneCare supports participating providers in their work to provide excellent health care to Vermonters. Through this partnership, OneCare moves Vermont toward a trusted, equitable health care system where patients and providers work together to achieve optimal health and an exceptional care experience. Learn more at onecarevt.org.
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About The University of Vermont Health Network:
The University of Vermont Health Network is an integrated system serving the residents of Vermont and northern New York with a shared mission: working together, we improve people’s lives. The partners are:
- The University of Vermont Medical Center
- The University of Vermont Health Network Medical Group
- The University of Vermont Health Network—Alice Hyde Medical Center
- The University of Vermont Health Network—Central Vermont Medical Center
- The University of Vermont Health Network—Elizabethtown Community Hospital
- The University of Vermont Health Network—Porter Medical Center
- The University of Vermont Health Network—Home Health & Hospice
Our 4,000 health care professionals are driven to provide high-quality, cost-efficient care as close to home as possible. Strengthened by our academic connection to the University of Vermont, each of our affiliates remains committed to its local community by providing compassionate, personal care shaped by the latest medical advances and delivered by highly skilled experts.
About Dartmouth-Hitchcock Health:
DARTMOUTH-HITCHCOCK HEALTH (D-HH), New Hampshire’s only academic health system and the state’s largest private employer, serves a population of 1.9 million across northern New England. D-HH provides access to more than 2,000 providers in almost every area of medicine, delivering care at its flagship hospital, Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, NH. DHMC was named again in 2020 as the #1 hospital in New Hampshire by U.S. News & World Report, and recognized for high performance in 9 clinical specialties and procedures. Dartmouth-Hitchcock Health includes the Norris Cotton Cancer Center, one of only 51 NCI-designated Comprehensive Cancer Centers in the nation; Children’s Hospital at Dartmouth-Hitchcock, the state’s only children’s hospital; member hospitals in Lebanon, Keene, and New London, NH, and Windsor, VT, and Visiting Nurse and Hospice for Vermont and New Hampshire; and 24 Dartmouth-Hitchcock clinics that provide ambulatory services across New Hampshire and Vermont. The D-HH system trains nearly 400 residents and fellows annually, and performs world-class research, in partnership with the Geisel School of Medicine at Dartmouth and the White River Junction VA Medical Center in White River Junction, VT.