Tag Archives: Doug Hoffer

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.

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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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A tale of two parties

For the third weekend in a row, Vermont’s top Democrats are touring the state, rallying their voters and presenting a unified front behind Sue Minter. Pat Leahy, Peter Welch, David Zuckerman, TJ Donovan, Doug Hoffer, Beth Pearce, and Jim Condos have done more than their share to help carry Minter across the finish line.

And most crucially, Bernie Sanders, who not only spent two weekends on the stump with Minter*, he gave her a tremendous infusion of campaign cash thanks to his millions of supporters across the country. It really has been a great display of unity — far beyond anything I’d hoped for when I advocated a one-weekend Bus Tour. It’s also an impressive show of the Democrats’ political star power, the depth of their talent and the breadth of their appeal.

*This weekend, he’s campaigning for Hillary Clinton in other states. 

Meanwhile, on the other side, we’ve got Phil Scott. And, um…

Phil Scott.

Bravely soldiering on, pretty much carrying the entire VTGOP on his broad, manly shoulders. Or trying to.

Really, who else is there? What other Vermont Republican might hope to draw a crowd or inspire the voters?

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Buy Local: It’s not just for pandering anymore

One of the more persistent strains of Philpuckey is his advocacy of Buying Local. He’s made it a regular theme of his Lite-Guvship, memorably captured in a front-page article in the Burlington Free Press last November that featured Phil Scott with his famous “Buy Local — It’s Not Just for Hippies Anymore” slogan.

(Which, first of all, “Buy Local” was never “just for hippies.” And second, it misunderstands the movement. Hippies were less concerned with where they bought their stuff, than with not buying stuff at all. It was an anti-consumption worldview. But hey, it’s just convenient shorthand for “long-haired weirdos”, right?)

“Buy Local” is an attractive pitch for Scott. It’s politically appealing, it reinforces his “real Vermonter” image and his status as a local business owner. It’s no-lose all the way around.

But coming from him, it’s effectively meaningless. Phil Scott may verbally support Buying Local, but if push comes to shove, he’ll opt for expediency. Proof: More than half his campaign’s total expenditures have gone to out-of-state firms and individuals. Latest example: a series of mass media buys since October 20, totaling $85,000, all going to out-of-state companies. That includes:

— $40,000 to D.C.-based Optimus Consulting, which has managed the Scott campaign’s media buys.

— $54,000 to Spectrum Marketing of Manchester, NH for “Media — Postcards.”

— $11,000 to SCM Associates of Dublin, NH, also for “Media — Postcards.”

Perhaps he needed some Washington Big Boys to buy spots on WCAX, but did he really need to go to New Hampshire for direct mail services?

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Hey kids! It’s time for Uncle Phil’s Funny Math!!!

So far, our political media has seen fit to abdicate its responsibility to fact-check the gubernatorial campaign. Instead, it has simply reported without comment the cornucopia of questionable numbers endlessly repeated by Phil Scott.

I do give ‘em credit for reporting Scott’s frequent non-answers and failures to give specifics on his own damn policy proposals. But they need to go farther. Especially since the Scott campaign has apparently decided not to respond to my own inquiries for substantiation.

Some of Scott’s figgers need a better man than I to assess, me not being a budget expert. But others are so transparently phony that even a muggle like me can see through them.

In this post, I’ll sometimes stand on the shoulders of Vermont’s number-one budget expert, Private Citizen* Doug Hoffer. In the absence of any oversight by the media, Hoffer has begun a projected series of essays examining Phil Scott’s favorite numbers.

*He’s also State Auditor, but he’s writing these pieces outside the auspices of his elected position.

First, let’s take Phil Scott’s constant claim that taxes and fees have risen by $700 million during the past six years of Democratic governance. Team Scott has failed to provide any documentation, but there is a little something in his economic plan.

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Lie down with dogs, get up with fleas — UPDATED with more fleas

Hey, you know about the Mylan controversy? Yeah, the company that bought the rights to the EpiPen and then jacked up the price by several gazillion percent? It now charges nearly $500 for a gizmo that probably cost them about three bucks to make.

Well, I’d managed to forget, or suppress, its Vermont connection until I was reminded by recent accounts in VTDigger and the Burlington Free Press. To wit, the Shumlin administration arranged a peculiar land swap in St. Albans to facilitate an expansion of Mylan’s operations here.

A land swap that costs the General Fund about a half million dollars a year.

(That’s about the price tag we “couldn’t afford” to spend on an Ethics Commission. Just sayin’.)

UPDATE: As Auditor Doug Hoffer points out, Mylan is also a beneficiary of the Vermont Employment Growth Initiative (VEGI) program to the tune of $5.7 million. More on this below.

I won’t rehash all the details here; you can check out VTDigger’s 2013 story, which lays it all out in excruciating detail.  I will note one thing before moving on: this turd blossom featured the guy I’m beginning to think of as the Joe Btfsplk of the Shumlin administration.

The idea… was largely the brainchild of Lawrence Miller, the Commerce Secretary.

Mmmyeah, EB-5, the endless Vermont Health Connect reboot, and now Mylan. Quite the resume you’re building, Mr. Miller.

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Is this the most useless policy review ever?

Hey, here’s some good news. One of Vermont’s more problematic job-creation programs is getting a policy review.

Unfortunately, that’s where the good news ends.

The program is the Vermont Employment Growth Initiative, or VEGI for short. It provides incentives to employers who grow jobs in Vermont. The most frequent VEGI beneficiary is Keurig Green Mountain, which has raised eyebrows in some quarters, (“Fascinating,” I have found myself saying with left brow cocked, “but highly illogical.”) That’s because KGM’s rapid growth was fueled, not by the state’s generosity, but by its then patent-protected K-Cup brewing system.

Since its patents expired, it has struggled to maintain market share, bungled two key product rollouts, and — VEGI grants or no VEGI grants — laid off hundreds of Vermonters.

So yeah, I’m all for a review of this program. Unfortunately, this is a fox/henhouse situation. The people doing the review are members of the Vermont Economic Progress Council, the panel that awards the VEGI grants in the first place.

Uh-huh, they’re reviewing their own work.

That ought to go well.

But wait, there’s more!

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