A Letter from the CEO on OneCare’s 2020 Budget Submission

This week, OneCare Vermont—our state’s accountable care organization (ACO)—will present our budget to the Green Mountain Care Board, which closely and carefully regulates our work. The budget we are submitting is responsible, and only 1.4% of it funds OneCare’s operations, most of which is used to directly support providers. The remainder of the budget consists of existing Medicare, Medicaid and commercial insurance dollars—not new spending.

I am still new in my role as CEO but it quickly became clear to me that there is a lot of confusion and misinformation about our work. This may not be surprising given how immensely complex health care is in general. Still, in order for our work to succeed, we need to do a better job educating and inviting people in to learn more. I am a nurse and I carry with me in this new role the very reason I got into heath care – to make a difference in my community.

For background, ACOs were created by the Federal Affordable Care Act. They are groups of health care providers that voluntarily join together to coordinate high quality care for patients while focusing on primary care and disease prevention. Here in Vermont, our ACO—OneCare Vermont—is enabled by the state and federal government through what we call the All-Payer Model, or APM.

The APM shifts our focus from treating illness and disease once they have occurred to preventing onset in the first place.We call this delivery system reform. We also have to change the way we pay providers (hospitals, physicians and others) so they can focus their time and resources on wellness and prevention. Instead of a payment for every individual office visit, test and procedure, providers receive a single payment to care for their patients. We call this payment reform.

Together these reform efforts make a real difference for Vermonters. We are working to expand and reimagine primary care. We are working to prevent diabetes and heart disease. We are working to manage chronic conditions alongside patients so that they feel better, live longer and don’t have to visit the emergency room. We are providing new services to people at home and keeping them from ever being admitted to the hospital. We are also helping providers and communities expand care to the areas of food, exercise, transportation and housing because we know access to these fundamentals improves health.

Health care will not serve us better or cost less until we do things differently—which means paying for value instead of volume, wellness instead of illness. That’s the APM. The rest of the country is moving in this direction, but nowhere in the nation is it happening in a more thoughtful and concerted way than here in Vermont.

As part of our state’s history of innovative health reform, OneCare is fully committed to a transparent and collaborative approach. From a governance standpoint, we are locally-led. The Board and management team include leaders who have spent their entire careers improving health care in Vermont.

We have a lot more work to do. The model is still in the early stages and, as it grows, we will need to do more to keep our regulators, lawmakers and stakeholders informed. I am committed to transparency and accountability, and we will address questions asked by our state regulators, Vermont’s Health Care Advocate, and the public in this process.

I hope this overview of our work has been informative. As the model matures and new Vermonters join OneCare, we will work even harder to share information.

FY2020 ACO Budget Materials are available for viewing on Green Mountain Care Board’s website at:
https://gmcboard.vermont.gov/aco-oversight