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.
Got it.
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.
The Vermont Political Observer. 
John – one simple google search pulled up this: “Multiple studies show that patient-centered care improves patient satisfaction, quality of care, and health outcomes while reducing health care costs and disparities in health care” https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2009.0888
So not a fan of OneCare or how our GMCB is handling the shift to patient centered care, but it might be good if you took a second to google “does patient centered health care lead to better health” before declaring it a failure in your lede – first result “Multiple studies show that patient-centered care improves patient satisfaction, quality of care, and health outcomes while reducing health care costs and disparities in health care” https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2009.0888
file under business as usual
Dear Mr. Walters,
After reading your “Seven Days” column regularly, and chatting with you at a fund raiser for Christine Hallquist last year, I was happy to get onto the list for your e-mail column.
However, may I make a suggestion? It would be great if you would abide by whatever the language restrictions were at “Seven Days”. The use of inappropriate language in the e-mail column unfortunately seems to be accelerating ☹️.
As Rachel Maddow would say, “Much appreciated!”
(Mrs.) Jan Abbott Essex Junction
>
“What kind of large-scale organization launches a series of initiatives with no intent to evaluate each one’s impact?” EVERY GOVERNMENT PROGRAM EVER! I’ll tell you a story… Back when I was doing freelance advertising a colleague and I pitched a state project for mental health awareness. I asked the person in charge how they were going to measure the success of the campaign — a measurable number visits to a website? calls to a hotline? doctor visits? — as this was key to crafting the correct call to action. Her answer was, “We will succeed by choosing the best ad.” Well, how do you know which is the best ad, I inquired. The answer: “We’ll know its the best because we chose it.” Yup. They had received a $100,000 grant for an ad campaign, and their mission was to spend $100,000 on an ad campaign. No interest in evaluating whether it was money well spent or not. And no incentive to find out. The government goofs in charge got paid the same whether people reached out for help or not. OneCare is the same mentality on a much larger scale. Your Hanniford’s comparison is a good one. That’s a private company working in a competitive marketplace. You’re damn right they care about efficiency and results. If their system fails its customers, the cash for paychecks never materializes.
This is why I respect Doug Hoffer so much. He actually expects government programs to show results.
“OneCare is “not really understood by a lot of decision makers.”
Nice column and I, for one, do not mind the language as that is just calling it what it is underneath the fluff. I think it is highly appropriate. The above statement is also truer than its words:). It is also not understood at all by the general populace who cannot understand why they’re still facing 12% rate increases for BCBS if OneCare is supposed to lower costs.