Daily Archives: October 25, 2019

I don’t know why Doug Hoffer puts up with our bullshit

State Auditor Doug Hoffer is at it again, pointing out the turds in the carefully curated punchbowls of state government. This time, it’s OneCareVermont, the massive, publicly-funded and poorly-understood initiative that seeks to reinvent the economics of health care by paying providers per patient instead of per treatment. The idea is that providers will be incentivized to encourage health instead of waiting to treat disease. (Not that there’s any evidence whatsoever that doctors and nurses can effectively change lifelong behavioral patterns that lead to chronic conditions like obesity and diabetes, lookin’ in the mirror there.)

Of course, the entity seeking to reinvent health care is owned by the two dominant providers in the current system, University of Vermont Medical Center and Dartmouth-Hitchcock Medical Center. Kind of like the foxes guarding the henhouse, except they’re big ol’ grizzly bears.

Hoffer had the audacity to take a look at OneCare’s commitment to some creative community-based health programs, including efforts to encourage healthy food shopping and meal prep and providing palliative care. And he found — shocking, I know — that OneCare, having accepted millions in public dollars for those programs, had no evidence whatsoever that they had any effect. At all. (Link is to VTDigger’s story. You can read Hoffer’s memo here.)

In fact, the behemoth isn’t even pretending to try.

OneCare CEO Vicki Loner faulted Hoffer’s “expectation for documentation of every activity.” Instead, OneCare is evaluating the outcomes for the system as a whole.

Which, if true, is just fuckin’ dumb.

What kind of large-scale organization launches a series of initiatives with no intent to evaluate each one’s impact? If you’re evaluating the system as a whole, how do you figure out which parts of the system work and which are a waste of time and money? Do you think the good folks at Hannaford don’t bother to track sales and profit margins in each department (or in each individual store), as long as they’re getting good outcomes for their system as a whole?

Even worse, OneCare is taking public money for specific programs and refusing to be accountable for how effectively it’s being spent. Which is ironic, don’tcha think, for a so-called Accountable Care Organization?

But if you think Hoffer is getting a hero’s welcome for his work, then you haven’t been paying attention to his tenure as auditor. Because his reward never comes in the form of gratitude and promises to enact reforms. No, his work is greeted with deliberately misdirected criticism and claims that reforms are already in the works. And, as quickly as possible, his work is dumped in the circular file.

Like I said, I don’t know why he puts up with our bullshit.

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State business grant gets flushed down the crapper

Bad news from down Bennington way, courtesy of The Banner:

With a two-paragraph note Thursday afternoon, a major Bennington employer for decades — Energizer — confirmed that the local factory will close.

Well, there go some nice manufacturing jobs in a community that’s taken more than its share of body blows. How many jobs is apparently a mystery; Energizer didn’t say, and The Banner couldn’t immediately find out. In 2015, the factory was downsized to an undisclosed extent (companies have learned to conceal the grim details of cutbacks and closings); at the time, per VTDigger, it employed “between 100 and 250 people.”

Sen. Dick Sears of Bennington learned of the plant’s closure — after the fact — in an email from a corporate stooge who offered hollow words of praise for “the years of productive engagement we have had with you and your office.”

That “productive engagement,” by the way, included a Vermont Training Program grant issued in April 2018 — only a year and a half ago. VTP provides taxpayer funds to cover up to 50 percent of training new workers or teaching new skills to existing workers.

I’m not sure, but I’m gonna guess here that Vermont had something a little more… uh, permanent in mind when it gave Energizer those dollars. Instead, the company didn’t even bother to inform state government until after it had publicly announced the plant closure.

Nice.

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