BURLINGTON – A nonprofit that oversees the health spending of more than a third of Vermonters will be part of the University of Vermont health network, the state’s largest provider, officials said this week of health.
Effective October 1, the UVM Health Network will become the parent company of OneCare Vermont, a responsible healthcare organization that routes hundreds of millions of Medicare and Medicaid payments to providers statewide. The network is already the umbrella of several hospitals, clinics and care facilities for the elderly.
The structural change in the governance of OneCare will allow the two organizations to combine services that are now duplicated, according to Victoria Loner, CEO of OneCare. For example, UVM Health Network will absorb accounting and data collection for OneCare.
The move is the latest in UVM Health Network’s consolidation of power in Vermont’s healthcare industry – and is sure to attract criticism from those who think the sprawling nonprofit has too control over the spending and delivery of health care in the state.
Loner said the network’s expanded role would not affect OneCare’s commitment to improving medical care for the people of Vermont.
“OneCare is, in its current form, a very stable organization that has seen astronomical growth over the past two years,” she said. “And to be able to continue this growth, it would take additional resources in the organization.”
Dartmouth-Hitchcock Health, co-founder of OneCare with UVM Health Network, will retain a seat on the association’s board of directors.
“This is really just a structural change to improve the sustainability of OneCare,” said Steve LeBlanc, chief strategy officer for Dartmouth-Hitchcock Health. “Dartmouth-Hitchcock Health is fully committed to remaining a participant. ”
UVM Health Network President and CEO John Brumsted said these changes could technically take place under OneCare’s current governance structure, but since Dartmouth-Hitchcock cares less about Vermonters compared at UVM, the structural change was cautious.
“It makes more sense that this integration occurs with the component of the delivery system that serves the patient population the most,” he added.
Integrating OneCare into the UVM health network was not a one-sided decision, LeBlanc said. This “was done as part of a strict strategic planning process that was undertaken at OneCare,” he said at a press conference Thursday.
“We all agree that it made sense to improve the efficiency and sustainability of OneCare through tighter connections and the ability to share resources with the UVM Health Network,” he said.
Brumsted said: “It’s a way of aligning incentives and aligning the way we deliver care. So it is higher value, higher quality and lower cost.
While OneCare would be a subsidiary under the UVM Health Network, Brumsted said the network would not have an inordinate influence over decisions that impact all system providers from all payers. OneCare’s board of directors would remain intact and policy decisions that affect the Vermont healthcare market would be made at the board level, he said.
UVM Health Network operates three hospitals in Vermont and three facilities in New York City and has been a dominant presence on OneCare’s board of directors. Vermont hospitals – UVM Medical Center in Burlington, Central Vermont Medical Center in Barre, and Porter Medical Center in Middlebury – are expected to collect $ 1.8 billion in revenue from patients in fiscal 2022, accounting for roughly two-thirds of health care spending in Vermont. With approximately 700 beds in Vermont, the network is the state’s largest provider.
Key leadership positions on OneCare’s board of directors are held by network executives. Brumsted is Chairman of the Board of OneCare. Rick Vincent, CFO of UVM Medical Center, chairs the board finance committee.
Loner stressed that the network’s oversight of OneCare’s operations would not constitute a conflict of interest.
“OneCare remains a 501 (c) (3) independent,” Loner said. “It’s about changing the parent organization – our membership status – which will allow us to streamline and have these efficiencies with one parent organization rather than two.”
Under the new organizational structure, the balance of power within OneCare’s 21-member board of directors will also change.
Dartmouth-Hitchcock loses two of its three seats and UVM Health Network wins an additional, bringing its representation to four. Providers from other parts of the health care system, including community hospitals, mental health agencies and independent practices occupy the remaining 15 seats. A representative of the community will be appointed to the last remaining vacant seat by DH.
In 2016, the Centers for Medicare and Medicaid Services granted a five-year waiver to the state of Vermont to embark on a new healthcare reform project that would allow a new responsible care organization to distribute federal funds. state hospitals and other providers.
The contract with the federal government expires this year. The state was about to ask the Centers for Medicare and Medicaid Services for a five-year extension. Instead, he’s now asking for a year.
Ena Backus, director of state health care reform, said in a public hearing Thursday that the change was needed due to “anomalies with the COVID-19 public health emergency.” The state also hopes it will have more time to work with providers, payers, and the public before seeking a longer-term extension from the U.S. Centers for Medicare and Medicaid Services.
OneCare Vermont was formed as a joint venture of the University of Vermont Health Network and Dartmouth-Hitchcock Health to implement the All Payors System.
The OneCare pilot project operations were supported by UVM, DH and 10 other member hospitals statewide.
OneCare was originally a for-profit entity. Last year the company became a nonprofit following reports by VTDigger of a lack of pay transparency, pressure from the Social Services Agency and the Legislature, and a lawsuit. filed by the auditor concerning the remuneration data.
Over the past five years, OneCare has changed the way healthcare is paid for in Vermont. The company receives hundreds of millions of dollars from Medicaid, Medicare, and commercial insurance and distributes the money to hospitals and doctors based on the population served by those providers. Instead of reimbursing healthcare companies for every blood test or doctor’s appointment, OneCare pays a flat fee per patient.
As part of the system, smaller hospitals, such as Springfield and Brattleboro Memorial Hospitals, received less federal funding, while Burlington’s UVM Medical Center saw an increase.
Overall, OneCare’s implementation of the all-pay system is expected to reduce the cost of care and improve the quality of patient care. But after five years, OneCare has not demonstrated the level of savings promised or a dramatic improvement in patient care, according to a recent report by a state auditor.
OneCare also failed to meet population targets. Currently, the responsible care organization was supposed to distribute payments to statewide providers for nearly all Vermonters, including those who are part of the commercial insurance system. As of July 2020, approximately 228,000 Vermonters were participating in OneCare, more than double the figure of 100,000 in July 2018, according to Green Mountain Care Board records.
Thursday’s public hearing on extending the exemption for all payers for another year became a referendum on the network’s takeover of the experimental payments system.
Patrick Flood, the former deputy secretary of the Social Services Agency, which manages the Medicaid program in Vermont, told regulators that allowing the UVM Health Network to become the parent company of OneCare “is a conflict of blatant interests “.
“I can’t even imagine the circumstances under which this could be handled in a fair, just and transparent manner,” Flood said. “So at this point I understand that it is clear to me that we are not going to get into this discussion … and you are not ready to give direct answers to questions that arise on this matter, so take it just as a comment. “
Julie Wasserman, a health policy consultant who worked as director of Vermont’s Dual Eligible Initiative, for Medicaid and Medicare Eligible Seniors, said Thursday during the hearing that there is potential “for a significant conflict of interest with UVM Health Network, controlling Medicare, Medicaid and its in-house responsible care organization as OneCare receives money from payers (Medicaid, Medicare, and insurance companies) and then pays providers, which include UVM Medical Center, which is owned by UVM Health Network.
“UVM Health Network will basically pay for itself through its ACO,” she said. “So my question for you is, how can the state let the UVM Health Network pay for itself?” “