Tag Archives: OneCare Vermont

The Dangerous Drift of Vermont’s Health Care System

When he was governor, Peter Shumlin made a big push on health care reform. It didn’t end well for reform or for Shumlin. Since then, the system has become less functional and more expensive but there’s been no appetite for another push.

With one major exception, and that’s OneCare Vermont. It has soldiered on in its effort to rein in health care costs by paying providers for outcomes rather than treatment. It has spent a tremendous amount of money, but so far there’s not much evidence of impact.

That’s troubling, and it’s more so when you read VTDigger’s piece about the latest Green Mountain Care Board meeting. Beyond that, there’s a broader critique of our health care system in a recent series of essays by journalist and health care policy analyst Hamilton Davis. Taken together, it looks like a huge sector of our economy (upon which our physical and financial well-being depends) is drifting along with a bunch of people who call themselves “Captain” staying as far away from the helm as they can.

The Digger article makes the leaders of OneCare look like The Gang That Couldn’t Shoot Straight. The GMCB, especially its new members, were asking questions that shouldn’t have been tough to answer. For instance, do you have any evidence that your system is working? Can you point to measurable results in terms of cost savings or improved outcomes?

OneCare leaders seemed to be taken aback by this line of questioning.

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Court Locks Black Box

Do high courts do Friday newsdumps? It would seem so. The Vermont Supreme Court issued a ruling on Friday, July 1 — heading into a three-day holiday weekend — with massive implications for independent oversight of OneCare Vermont, our favorite too-big-to-fail institution, and for the state auditor’s office.

The newsdump worked like a charm. VTDigger cranked out a quickie same-day story that hit the Internet at a time when lots of people had stopped paying attention to the news. By Tuesday, July 5, the decision had pretty much vanished from public attention. A strong statement from Auditor Doug Hoffer blasting the decision went largely unnoticed. But I sure hope responsible parties in the Legislature have taken note, because something needs to be done to fix this.

The unanimous decision denied Hoffer access to OneCare’s payroll information. He had sought access after OneCare’s payroll and benefits expenses jumped from $8.7 million in fiscal year 2019 to $11.8 million the following year. He understandably wanted to find out why. It’s an issue that should concern us all because OneCare is (a) kind of a rolling experiment that’s (b) playing with massive amounts of public money for which it is (c) not very accountable at all.

I’ll get back to OneCare, our most mysterious of public sector black boxes, but first I want to discuss the Auditor’s part of this. The court ruled that the Auditor has no authority in statute or in contract to access OneCare’s financial records. It asserted that financial oversight belongs solely to the Green Mountain Care Board, which is essentially OneCare’s captive partner in this grand experiment.

Well then, I ask, what in hell do we have an auditor for?

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The Assassination of OneCare Vermont by the Coward Douglas Hoffer

Not exactly convincing, I have to admit

The townsfolk are all horns and rattles, I never seen such a fuss. Must be that cold-blooded sidewinder Doug Hoffer’s back in town and up to no good.

This time, the ol’ gunslinger has taken aim at OneCare Vermont. Hoffer’released an audit on Monday finding that OneCare, which was supposed to glean savings from the healthcare system, has cost millions more than it’s saved.

The normal official response to a Hoffer audit is along the lines of “Well, he found some interesting information, but nothing we didn’t already know and weren’t already doing something about.” But the reaction to this audit is more direct, if not downright hostile. Mind you, they didn’t contest Hoffer’s findings, not at all. But they didn’t like his conclusions, not one little bit.

One might even detect a faint whiff of panic. Considering that free-lance health care expert Hamilton Davis just called OneCare “a dumpster fire,” I can see why Our Leaders would be unreceptive to a critical audit right now.

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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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