It is clear that we need to enhance our healthcare system to better meet the needs of Vermonters, support providers, improve health outcomes, and control costs. Vermont has a long history of healthcare innovation—the most recent example being the agreement it entered with the federal government to institute an All-Payer Model. This model is regulated by the Green Mountain Care Board and seeks to work with payers (Medicaid, Medicare, and commercial insurers) to control health care spending, which inherently requires investing in prevention as a means to avoid high-cost care—also known as investing in “value-based care.”
“When the State of Vermont signed the Vermont All-Payer Model agreement, they basically said, ‘we would like to see value-based healthcare expand within the state.’ There are a couple different ways to go about it. First, is you let the industry just organically transition—that to me is inefficient. It requires every provider to individually contract with every payer,” remarks Tom Borys, VP of Finance at OneCare Vermont. He continues, “And this type of model will take a tremendous amount of time, we’re talking decades to get it really far along on the path. Alternatively, you can use an organization like OneCare—OneCare can bring together a network of healthcare providers, and then as a unit, in a singular way, contract with the payers. So one contract with Medicaid, for example, can then be passed through to dozens of providers across the state, that is a path to spread value-based care much quicker, and much more efficiently.”
This is value that OneCare brings to the All-Payer Model—by working through an accountable care organization, one entity can navigate all the different ways each insurance payer works, their different quality measures, different codes, etc. OneCare is helping the State of Vermont make progress toward their All-Payer Model agreement with the federal government. “If you ask me, Vermont’s been smart and said, ‘let’s do it once, rather than do it thousands of times across our state,’” says Borys.
While OneCare is working closely with the State on the All-Payer Model goals, the organization exists to serve providers that participate in the OneCare accountable care organization and support them in providing the best care possible to their patients. Through its network performance management core capability, it first puts the payer contracts in place for providers and next helps providers succeed by supporting primary prevention efforts, facilitating care coordination, and monitoring quality measures to achieve better patient health outcomes. Additionally, OneCare’s two other core capabilities support providers: data and analytics gives providers the information they need about their patient populations and payment reform stabilizes costs by providing predictable payments.
OneCare convenes providers to give excellent care at a stable cost. Care coordination requires a strong relationship between the patient, their primary care provider, and other members of a person’s care team; OneCare provides tools and resources to help facilitate this coordination. With OneCare tools and support, providers work together across organizations to help patients access the care they need and avoid expensive duplicate services. Providers share information about what is happening with the patients they are all caring for—if the person is admitted or discharged from the hospital, if social or economic factors put patients at risk, or if a change in their mental health has occurred. That way, providers caring for the same patient can quickly identify ways to address their needs and the patient only has to tell their story once.
Meanwhile, population level data and support to implement best practices for improving quality of care delivered in clinical settings is achieved with OneCare’s quality improvement team. Quality measures ensure providers are monitoring and striving to improve health outcomes. Health care organizations with high scores on standardized measures of quality earn funding for innovative programs and health promotion efforts—funding that can be reinvested into their practices to further improve quality and access to care.
Through its multi-pronged approach to changing the way health care is paid for and delivered, OneCare is committed to enhancing Vermont’s healthcare system by supporting providers in the transition to value-based care. We also support the State of Vermont in their efforts to change the system—and, that means supporting the All-Payer Model. Despite the support for the All-Payer model, Borys notes that OneCare Vermont is not at odds with a single-payer system if that were ever to be a model pursued locally or nationally. Borys states, “In fact, if Vermont had a single payer system, as a taxpayer, I’d want there to be a value-based model built around it to ensure that providers are accountable for delivering excellent health care, we have excellent quality, and those who are doing a really good job are rewarded.” This perspective highlights OneCare’s commitment to value-based care as a means to controlling costs and achieving optimal health for Vermonters.