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.
Susan Barrett, executive director of the Green Mountain Care Board — you know, the regulatory agency that’s supposed to be riding herd on OneCareVermont — reacted as though Hoffer had put the turd in the bowl himself. Digger:
The board had a different interpretation of the rules governing OneCare, Barrett said, and OneCare did in fact meet the requirements.
Two things. First, Doug Hoffer is not a complete doofus. He does his work thoroughly and carefully. And second, while Barrett claimed that OneCare was in compliance, she also admitted “that OneCare Vermont should have a more robust system for tracking community-based initiatives.”
To recap: OneCare is doing just fine, but they have to change the way they do things.
GMCB chair Kevin Mullin did the happy-face version of Barrett’s routine, thanking Hoffer for “taking an active approach to help Vermonters understand the health care reform initiatives that are taking place.”
To recap: Shitcan this memo as quickly as possible. I mean, thanking Hoffer for helping Vermonters understand? No, Hoffer was trying to help state regulators understand a deep flaw in the system. Somehow I don’t think they’re interested.
I hope Mullin has an industrial-sized circular file, because Hoffer isn’t done with OneCare. His office is undertaking a full performance audit of the entire shebang. And as deputy auditor Andrew Stein told Digger, OneCare is “not really understood by a lot of decision makers.”
You got that right.