Green Mountain Care Board approves OneCare’s 2022 budget

OneCare Vermont won approval this week from the Green Mountain Care Board for its 2022 budget, but was instructed by the board to increase the financial stakes for hospitals. The $15.3 million operating budget will enable OneCare to oversee $1.3 billion of the state’s health care costs next year.

In its unanimous budget vote Wednesday, Vermont’s health care regulatory board also called on OneCare to rank itself against other accountable care organizations throughout the country. Earlier in the week, OneCare CEO Vicki Loner had pushed back on the idea, writing in a letter to the board that such comparisons should “not be directed by a regulatory body.”

Kevin Mullin, who heads the Green Mountain Care Board, disagreed. 

“We’re not trying to micromanage them,” he said in an interview after Wednesday’s vote. “We’re just trying to make sure that any lessons that can be learned by successful ACOs around the country are learned, and that they are on the right track.”

OneCare is part of a statewide effort to shift the way insurers pay for health care — that is, to pay providers a flat fee to keep patients healthy, rather than pay for every service, such as blood tests, doctor’s appointments and hospital visits.  

Under the all-payer model, hospitals share any savings, but are also required to absorb financial losses from care.

The board allowed OneCare to loosen up the financial risk to hospitals during the first uncertain months of the coronavirus pandemic. The incentives and penalties stayed low throughout 2021, and OneCare executives wanted to keep it that way in 2022. 

On Wednesday, however, the board voted to increase the risk/reward investments to pre-pandemic levels. 

In her Dec. 20 letter to the board, Loner warned that could “destabilize OneCare’s reform program” and create distrust that could prompt some providers to abandon the all-payer model. But Mullin said the lower risk/reward investments aren’t sufficient to drive meaningful change in Vermont’s health care system. 

The board called on OneCare to increase those investments to $2.2 million in 2022 — up from the $1.5 million OneCare had proposed.

The board also allowed OneCare to increase hospital dues by $3.6 million, to $18.6 million, next year. 

OneCare’s board-approved operating budget of $15.3 million, which was shaped by about three months of oversight hearings, will be roughly the same as in 2021. The organization will cover about 188,000 people in 2022, roughly the same as this year. 

OneCare, which is under the University of Vermont Health Network umbrella, has consistently fallen short of its enrollment targets. The plan was to have 70% of all Vermonters participating in the all-payer model by the end of 2022, but only 57% are enrolled so far, according to a recent Green Mountain Care Board report.

OneCare recently has gone through substantial changes. John Brumsted, the longtime University of Vermont Health Network chief executive, announced he was stepping down as leader of the accountable care organization’s board. Last month, the UVM Health Network became the sole parent organization of OneCare; it had been a joint venture of Dartmouth-Hitchcock Medical Center and UVM Medical Center. 

Brumsted said the new governance structure is part of an effort to course-correct after the U.S. Centers for Medicare and Medicaid Services put the state on notice for missing enrollment benchmarks in 2018 and 2019.

Vermont is entering the final year of a five-year agreement with the federal government on the all-payer model, enacting what was supposed to be a sweeping shift to value-based care. The state is now seeking a one-year extension of the federal agreement, hoping to negotiate a longer agreement at a later date.