Tag Archives: Green Mountain Care Board

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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Single-payer price tag: the dollars matter less than what they bought

Another fine “Fair Game” column by Seven Days politimeister Paul Heintz, most of which is an attempt to put a price tag on Gov. Shumlin’s failed pursuit of single-payer health care.

The takeaway number: $2 million. But that comes with some major cutouts; if you changed the ground rules, you could come up with a much higher number.

Heintz sought that number for ten weeks before the administration finally came up with it. And after all that time, all they did was add up two numbers: $597,000 to ten consultants, and $1.33 million spent on the governor’s Office of Health Care Reform.

However… the consultants and the OHCR weren’t the only people who put in time on single-payer. Work was also done by staffers in “10 offices, departments and agencies.” There was lobbying and flackery on behalf of single-payer. And many millions were spent on the Green Mountain Care Board and other entities that might not have existed, or been nearly so expensive, if not for their work on single-payer.

So, $2 million. Or a lot more, your choice.

The big question, though: was that too much? And the answer is, it depends.

If it was spent well and wisely, then $2 million or even $20 million would be a perfectly reasonable investment in research on a huge policy initiative. If it was spent poorly, then $2 million or $2,000 would be a waste.

So it depends. If you oppose single-payer, it’s an outrage. If you favor single-payer and believe the governor did his best, it’s reasonable.

And if, like me and many other single-payer supporters, you have your doubts regarding the administration’s performance, then that $2 million figure will make you a bit more queasy about the whole enterprise.


Talk about a waste of money…

Governor Shumlin appears to have his knickers in a knot over Vermont Information Technology Leaders’ decision to buy ad time during the Super Bowl.

Bear in mind we’re not talking about a Budweiser-level national buy; VITL bought one spot on channel 5 at a cost of $13,000. A waste of money? Arguably, perhaps; but VITL is trying to raise its public profile, and that 13K was part of a $195,000 marketing campaign.

Shumlin told the Vermont Press Bureau’s Neal Goswami that he was “disappointed” by VITL’s move. Well, he put it more grandly: “Many Vermonters joined me in being disappointed that state and federal funds were being used for an advertising buy during the Super Bowl.”

Yeah, “many Vermonters.” Why, just the other day I heard the folks at Coffee Corner’s front table griping about that waste of $13,000.


And then Shumlin got to the real meat of his objection.

“This should highlight the need for the Green Mountain Care Board to regulate VITL’s expenditures,” Shumlin said Sunday.

Aha, the penny drops. VITL is currently an independent nonprofit organization that “helps health care providers adopt and use IT systems.” Shumlin wants GMCB to have authority over VITL spending. And now he’s publicly scolding VITL for its horrifically wasteful use of… ahem… $13,000.

Smells like a power play to me.

Now, I’d love to have an extra 13 large. It’s nothing to sniff at. But as part of a sizable organization’s marketing campaign? Certainly not worth the Governor’s attention. Let’s say, hypothetically, that GMCB already had the authority. Would it be micromanaging VITL’s budget to that extent? I don’t think so.

Besides, if you want to talk about wasting money, let’s look at the taxpayers’ $2.5 million donation to GlobalFoundries, as ordered by our provident Governor.

GlobalFoundries, you may recall, “bought” IBM’s computer chip operations, including the facility in Essex Junction, for a whopping negative $1.5 billion. Last month, Shumlin announced he intends to hand over $2.5 million in state incentives to GlobalFoundries. That’ll clean out the Vermont Enterprise Fund, which was created last year at Shumlin’s behest. It’s supposed to help encourage large employers to remain or relocate in Vermont, and spending it is a gubernatorial prerogative.

As VTDigger’s Carolyn Shapiro reported, it’s unclear “how the money will be used and what conditions, if any, GlobalFoundries will have to meet.”

If any. Snort.

The Governor said the money “will help the state build a relationship” with its new corporate occupant.

Think of it as a $2.5 million corsage for a prom date.

Because when you’re talking about a giant corporation that does business in billions, $2.5 million is nothing but a gesture. Will it do anything to keep GlobalFoundries in Vermont or get them to expand? No. Corporate decisions will be made with global concerns in mind. On that scale, $2.5 million is a rounding error.

The Governor might as well have taken that money, in bags of small bills, to GlobalFoundries’ front gate and set fire to it, in hopes that the sweet, sweet smoke would appease the corporate gods.

The fundamental problem is, Vermont can’t move the numbers significantly enough to affect decisions at that level. We will always be at the mercy of large employers, and we’ll be playing with a short stack against bigger states (and countries) that can offer much bigger incentives. We’d be better off taking that $2.5 million and investing it in something that might actually make a difference — say, in a revolving loan fund for startup businesses.

Or here’s an idea: A revolving loan fund for students pursuing two-year degrees in technology fields. Why, just the other day one of IBM’s top executives said that GlobalFoundries “is struggling to fill positions because they can’t find enough workers with a two-year technical degree.”

You want to keep them in Vermont and simultaneously grow opportunities for Vermonters? Access to education is much more relevant to GlobalFoundries than a burnt offering at their front gate.

Just spitballing. My point is that there have got to be better, more effective, business-friendly ways to spend that $2.5 million. And that’s a lot bigger waste than VITL’s $13,000 Super Bowl ad.

So, maybe health care reform is working?

For those of us who practice compassionate liberalism (which is actually a thing, unlike compassionate conservatism), the primary reason for health care reform is to ensure that everyone can access the services they need. But reform isn’t going to work unless it meets another goal: containing the costs of health care, which were out of control under the old system.

And here’s some good news on the green-eyeshade front, courtesy of VPR:

Vermont’s 14 hospitals have submitted budgets for the fiscal year starting Oct. 1 that increase by just 2.6 percent over the current year’s budgets, the smallest annual increase for the Vermont health care delivery system in four decades.

… The 2.6 percent inflation figure follows on the heels of a 2.7 percent jump in the current year. Taken together, the performance of the hospital system should be considered a positive augury in the coming debate over Gov. Peter Shumlin’s single-payer reform initiative.

Kudos to VPR’s Hamilton Davis for slipping “positive augury” into his script. Few radio reporters would dare so much.

Anyway, yeah, two consecutive years of low cost increases for Vermont hospitals. In fact, as Davis reports, those increases are roughly one-third the rate of increase since the year 2000. And this year’s figures came in under the Green Mountain Care Board’s target of 3 percent. GMCB chair Al Gobeille pronounced himself “very pleased” with the submissions.

It’s still early days in health care reform, but something is obviously working. And this is a “positive augury” because state law requires the government to demonstrate an ability to control costs in order for Governor Shumlin’s single-payer health plan to go forward. So far, so good.