By EMERSON LYNN, co-publisher
It is arguably the most significant policy change in health care and most Vermonters have not heard about it. Of those who have, a small percentage can explain what it is, and how it is supposed to work.
And, to boot, this year it comes with a $900 million budget.
It’s OneCare Vermont, the accountable care organization that is on task to set up and to manage Vermont’s all-payer health care system. The first of its kind model was set up in 2016 and was designed as a partnership between Vermont and the federal Centers for Medicare and Medicaid Services. The point of the model is to shift from the traditional fee-for-service system, where doctors and hospitals are paid according to the services provided, to a “capitated” system in which health care providers are paid regular, predetermined amounts based on the populations served.
To say it’s a radical change in how Vermont is about to deal with its approach to health care is not an understatement. No one else in the nation has embarked on such a venture.
Generally, a solo venture would invite pause. This approach, however ambitious, is not only defensive, but essential. It has the twin goals of reducing costs and improving health care outcomes.
As complicated as the process is, it boils down to the recognition that the only way to reduce health care costs is to reduce usage. The only way to reduce usage is to get people to live healthier lives. The best way to get people to live healthier lives is to focus more on primary care initiatives.
It’s both highly progressive in its approach, and conservative in its nature, which is why it has strong appeal on both sides of the political aisles.
The worry, however, is that it can be picked apart by those who oppose change, and those who think it doesn’t go far enough.
That vulnerability exists because it’s virtually an unknown. It’s easy to pick something apart when it has a budget of $900 million and its operations are not understood. It’s easy to pick something apart if it doesn’t have articulate defenders beyond OneCare itself.
That brings us to the Green Mountain Care Board, the group of five that is responsible for passing judgment on OneCare Vermont’s budget.
If the board is committed to responsible budgeting going forward, then it should lend its strength to OneCare Vermont’s mission, and it should do so with a full throated, fully articulated explanation of OneCare’s importance.
It’s this five-person board that can put in place the underpinnings for Vermont’s evolution from a fee-for-service model to an all-payer model. They are the ones best positioned to explain its mission and defend its need.
To do anything less is to regress. To do less is to put the fate of the all-payer system at the mercy of those opposed to change, and those who use perfection as the enemy of the good to derail such programs.
The Green Mountain Care Board needs to tell OneCare Vermont’s story and it needs to put in place the support systems within our community hospitals to ensure its success. That includes RiseVt, the preventive health system that had its beginnings in Franklin and Grand Isle counties, which has now gone statewide.
Vermont is mid-step in its evolution to a health care system that has wellness, not sickness, as its focus. It’s a critical point in the debate. Vermonters should encourage the Green Mountain Care Board to explain and to defend OneCare Vermont and its purpose, which, in turn, would establish Vermont as a model of health care reform.
It’s hard to imagine a better, bigger billboard for a state keen on attracting growth.