OneCare: “Please make us too big to fail”

As VTDigger reported a few days ago, Vermont’s public sector unions are feeling a little dubious about turning over their health care benefits to OneCare Vermont, the accountable care organization that’s beginning to develop a record of scoring own goals. For instance, OneCare seems to be (inadvertently, one would hope) doing its best to validate the unions’ concerns.

OneCare is in the process of seeking a dominant position in Vermont’s health care marketplace, by signing up as many groups and individuals as possible to its model of paying providers for outcomes instead of services performed. It’s the current hot idea in health care, and many smart people see great promise in it.

Of course, go back eight years and a lot of smart people saw great promise in then-governor Shumlin’s single-payer idea. And we know how well that went.

A little more than a month ago, OneCare went before the Green Mountain Care Board with a request for a $1.36 billion budget — a whopping 33 percent increase over last year’s. See, it’s been losing money and failing to produce the cost savings it promised.

OneCare’s explanation: It’s not big enough. Digger:

“We can’t measure success without scale,” [OneCare] CEO Vicki Loner told the Green Mountain Care Board at its budget hearing last month. The more people who participate, the more effective the system will be, she said.

Yeah, well, that may be true. But it’s also an invitation to pour more money down what might turn out to be a rathole. Loner is essentially saying that OneCare has to become too big to fail, merely in order to adequately test its health care model.

VSEA chief Steve Howard is, unsurprisingly, balking at the RSVP.

“We have some of the best health care in the country,” Howard said. “We don’t want to screw that up just to pursue someone else’s agenda.”

I have to say, I sympathize with Howard here. OneCare Vermont has a poor initial track record. Why should public sector unions, which have fought hard to achieve and maintain good health benefits, sign on for that?

The problem is, OneCare probably can’t achieve the scale it claims to need without the unions. So we’re stuck.

At least for now. Howard says he might be persuaded by the results of a full audit from State Auditor Doug Hoffer, which should be coming in the next few months. Of course, Hoffer recently produced a decidedly unflattering memo concerning one aspect of OneCare’s activities, which may or may not be a preview of his full report — but it does, at minimum, indicate a healthy skepticism about OneCare’s so-far unrealized promise.

Loner’s assertion makes sense, but it requires an absolute buy-in by the state and thousands of Vermonters. And the core problem — needing a much larger scale to succeed — turned out to be the fatal flaw in ShummyCare. He finally gave up on the idea because he realized that Vermont wasn’t big enough to provide the needed scale.

That has nothing directly to do with OneCare, but it has to be concerning.

This is a high-stakes proposition for all concerned. The GMCB is positively disposed toward OneCare, to the extent of sometimes making excuses for its shortcomings, blaming the media for reporting bad news, and dismissing Hoffer’s recent memo.

Speaking of blaming the media, Loner has latched onto that tired old narrative big-time. She accused Digger of working hard to create “a biased narrative” about OneCare.

Blaming the media is not the last refuge of the scoundrel, but it’s one of the more popular ones. I just love it when public officials react to bad news by impugning the integrity of good journalists. And Katie Jickling, a former colleague at Seven Days who now covers health care for Digger, is a fine reporter who grinds no axes.

Here’s another thing. After having a single CEO since its inception in 2012, OneCare has had a total of three so far this year: Original CEO Todd Moore, interim CEO Kevin Stone and now Loner. Moore got a job at the Mayo Clinic. That’s a perfectly understandable move, but one has to question whether Moore got out while the getting was good — before it became known that OneCare was losing money and failing to produce savings.

I have no evidence to offer on that point, but it’s a valid question. Stone and Loner were both internal candidates; Stone was chair of the OneCare board, and had served on the board since 2012. Loner was vice president and chief operating officer when she was promoted to CEO in July; she’s been a OneCare executive since January 2013.

Which raises concerns about an insider-ish culture. Hiring internally has its benefits, but also carries risks. Can they see the forest for the trees? Can they objectively evaluate the company’s processes, or have they lost perspective? This isn’t a slam on the abilities of Stone or Loner, it’s just something that can happen when (a) you’ve been part of the same organization for a long time and (b) you’ve personally succeeded in that culture?

GMCB chair Kevin Mullin has advised Loner and OneCare to “tell a better story.” That seems a bit cheerleaderish, coming from OneCare’s top regulator. But it’s good advice. Loner should stop blaming the media for her company’s issues. Instead, she should carefully consider the reporting she sees as negative; it probably contains quite a bit of truth.

Especially when the stakes are so high — for her, for OneCare, for the state government and all Vermonters.


4 thoughts on “OneCare: “Please make us too big to fail”

  1. chuck gregory

    Shumlin judged Vermont wrongly about its size. Iceland has a plan which pays 85% of all medical costs for all citizens, and it has only half the population of Vermont. Our per capita state domestic product is greater than that of France, which has the best (at last reports) health care system in the world. This is what we get when we listen to anybody but doctors and patients.

  2. Robert Roper

    “Moore got a job at the Mayo Clinic. That’s a perfectly understandable move, but one has to question whether Moore got out while the getting was good — before it became known that OneCare was losing money and failing to produce savings.”

    Flashback to 2017: “Todd Moore, chief executive officer of OneCare, said everyone involved should have a feel for how well the new approach is working by 2019. If all goes according to plan, he said the new system will cut the annual growth in health care expenditures in half, saving hundreds of millions of dollars over five years and reducing insurance premiums for Vermonters.” (Burlington Free Press, 12/21/17)

    It’s 2019, and this dude pulled the rip cord on his parachute. You may be onto something, Mr. Walters.


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