OneCare Vermont is pleased to welcome a Derek Raynes as the Director of Payment Reform, a strategically important role at the center of the organization’s commitment to value-based health care. In this role, Raynes will provide comprehensive financial and payment reform leadership for OneCare.
I am thrilled to join the team at OneCare to work on transforming the way health care is paid for and delivered in Vermont. With my background in health care, I know that value-based care is here to stay. I look forward to working with providers and insurers to move Vermont’s healthcare system more firmly into a model that is designed to lead to better health outcomes for Vermonters.
Raynes comes to OneCare as the former Director of Contracting and Revenue Strategy at UVM Medical Center, Director of Managed Care and Network Development at Shands at the University of Florida, and most recently Managing General Partner at Raynes | Erickson, LLP.
Raynes completed his undergraduate work at The University of Colorado and earned a JD from California Western School of Law. As the Director of Payment Reform, Raynes will lead and coordinate OneCare’s financial reform functions, including contract negotiations, accountable care organization program performance evaluation, risk management, financial and population health analysis, and development and evaluation of provider payment reform models.
Raynes was born and raised in southern California where he has most recently been living, but is excited to return to Vermont with his wife, son, daughter, and yellow lab named Riley. Rayne’s is a golf enthusiast and he and his family look forward to skiing next winter and attending UVM hockey games when they return.
What is payment reform?
“Payment reform” refers to shifting health care provider focus from volume-based reimbursement (i.e. fee-for-service), to receiving monthly fixed amounts from OneCare to providers who choose to participate. These fixed amounts are based on historical fee-for-service spending to smooth the transition to value-based payments. Savings earned by providers in the OneCare network can be invested to lead to better health outcomes for Vermonters—like primary prevention efforts and additional care coordination services to support people with chronic illness. To implement payment reform, OneCare works with hospitals, independent primary care, and insurance companies.
To illustrate payment reform work in action, when the pandemic hit Vermont, the health care provider community faced unprecedented operational challenges and financial strains. OneCare aggressively searched for ways to provide financial relief to providers. OneCare was able to advance payments to primary care practices, home health, designated agencies, and area agencies on aging, as well return Value-Based Incentive Fund payments to hospitals.
Predictable cash flow helps health care organizations continue to provide necessary services to their communities, especially during uncertain times. OneCare is dedicated to increase participation in fixed payment programs to expand this value.