Last week, OneCare Vermont presented our 2022 budget to the Green Mountain Care Board (GMCB). OneCare initially filed our 2022 budget on October 1, 2021 with the Green Mountain Care Board (GMCB) as part of the annual budget review process. We are proud to have submitted a balanced budget despite financial challenges brought on by the current pandemic. Our budget continues to support our provider network through the ongoing COVID-19 public health emergency, and balances the cost of reform with continued investments in the value-based care transformation.
To balance the budget, our committees, board and key stakeholders provided valuable input and made difficult decisions about how to invest in population health management—budgeting to invest $29M in population health management across the continuum of care in 2022. Stakeholders agreed that care coordination is vital and continued to prioritize this investment in 2022. In addition, they focused on evolving the Comprehensive Payment Reform (CPR) program for independent primary care providers and continued investments in community-based providers.
OneCare Vermont’s own “Comprehensive Payment Reform” pilot project—aptly abbreviated “CPR”—changes the payment method from fee-for-service to a fixed monthly payment with which we can focus on taking the best care of the patients in our practices. This is the first real investment our independent primary care practices have seen. It has allowed us to provide better team-based care within our offices. We now have dedicated care coordinators who can help patients navigate complicated health and social situations. We have implemented more mental health and social services in our offices where patients can access them on site. We fully expect that this more integrated approach will have a positive effect on the health of our patients and communities.
During the budget presentation, OneCare leadership responded to clarifying questions on topics including changes to our operating agreement, the role of the chief medical officer, and evaluation of our ongoing progress. OneCare CEO Vicki Loner was also asked about what she is most proud of regarding OneCare’s work so far. Loner’s response:
“We have brought together over 5,000 providers—over 160 organization— who are agreeing to be in value-based programs and committing time, energy, resources, and money because they believe in this shift to value-based care. Whenever I talk to other ACOs around the country, they cannot believe the size, breadth, and depth of the participants that we have in our model. We should be rejoicing in that because it really is unheard of across the country.”
OneCare fills a unique niche in Vermont’s health care reform efforts. Moving forward, the organization will focus its activities and initiatives on providing the most value for its participating providers.
OneCare Vermont continues to serve as a positive force in our state’s health care reform journey by reducing administrative costs, supporting community health initiatives and preventive care, and curbing expensive hospital admissions. [For example], through the Skilled Nursing Facility Medicare Waiver with OneCare, BMH inpatients can be discharged and directly admitted to a skilled nursing facility without the otherwise-required three day wait. This waiver has now expanded to include discharges from the Emergency Department and primary care providers, all of which means that patients can have appropriate access to rehab services and receive the right level of care at the right time.
In 2022, OneCare’s proposed 2022 budget will make possible:
- Evolving the care coordination program and shifting prevention strategies to align with clinical and health equity focus areas and the commitment to improving the quality of care for individuals with hypertension and/or diabetes (or pre-conditions)
- Supporting its network of participating providers through increased focus on key quality improvement, care delivery, and health outcomes
- Simplifying payment programs and deepening participation in payment reform initiatives;
- Monitoring and/or refining key performance indicators
- Continuing collaboration with the Agency of Human Services (AHS), through its improvement plan, to identify areas of mutual interest and align resources
OneCare is an investment in Vermont’s future. There is no “plan B” for continuing a value-based care framework, systemically addressing population health, or providing data insights for Vermont’s provider community.
OneCare’s recent strategic planning process helped us focus on our core capabilities toward our goals to continue to stabilize health care costs and improve health. OneCare will do this through creating efficiency by negotiating value-based care contracts for providers; providing timely data and analytics to guide decision-making; investing in population health; and expanding value-based payments.
The fee-for-service health care system isn’t sustainable and the good work of OneCare to efficiently move our local system into a value-based care model is crucial to the success of health care reform efforts. This change is happening across the country and Vermont is no exception. As OneCare Vermont CEO, Vicki Loner said in a recent commentary published in VTDigger:
“In five years, what I want for providers is that the majority of their business is in value-based care, and so it’s more predictable. Value-based care is uncomplicated care. For patients and families, I just want it to be easier for them to understand—easier for them to get the services they need. Where I hope we will be in the next 10 to 20 years is that we will be thinking more about community wellness and prevention and spending more of our resources and capital in that area, and less on ambulances, and sick care, and hospitals. And the faster we can move into the value-based care world, the better off people will be.”