BURLINGTON, Vt. (WCAX) – A major initiative to change how health care is paid for in Vermont is coming to an end. The state announced Wednesday it is pulling the plug on OneCare, and instead will join a multistate accountable care organization effort that will pursue similar goals.
It’s an organization most Vermonters haven’t heard of, and even those who are a part of it likely wouldn’t even know.
“Our real focus is on preventative care and improvement of quality,” said Abe Berman, the CEO of OneCare Vermont.
Nearly a decade ago, Obamacare allowed Vermont to launch what’s known as the all-payer model. Doctors and providers serving about one-third of Vermonters are paid flat monthly checks from private and public insurance through OneCare. It’s aimed to help people access primary care, mental health, and in-home elder care with the goal of improving the overall health of Vermonters so they would need to access care less frequently, ultimately saving money.
“It’s so key for people who struggle with chronic illnesses. They’ve seen it as a source of financial support as well as information and tactical support,” Berman said. But at the end of next year, Vermont is joining a similar model partnering with other states, meaning OneCare will come to an end. “OneCare has done its part in this leg of the journey. It’s time to pass the baton to what comes next.”
The end of this chapter of health care reform has some wondering if it has paid off. In the years since OneCare’s launch, health care costs have skyrocketed and small businesses, school districts, and Vermonters are dealing with double-digit increases in health insurance. A state audit showed between 2017 and 2019, despite Vermont taxpayers paying OneCare $29 million, there was a $25 million net loss.
“It would be bad business to spend $2 to save one. Our audit found that’s what Vermont was doing,” said Vermont Deputy State Auditor Tim Ashe
OneCare denies costs have exceeded benefits, but measuring the benefits is murky. A cost-benefit analysis issued this year from regulators concluded it’s difficult to quantify the health of all Vermonters and isolate the impact of OneCare while including other stressors like COVID, opioids, and inflation.
“Things like the pandemic that interrupted this period made it hard to measure concretely what the benefits are. I can only go off of what our quality measures say and what our cost metrics — as they were set up to say — and what we hear anecdotally from providers,” Berman said.
Even so, some say if the goal is making Vermonters more healthy, the state should simply invest more in primary care.