Vermont’s auditor questions the coziness of OneCare and its regulator

July 10, 2020

By David Flemming

Government sanctioned monopolies don’t often benefit consumers- but that never stopped our Legislature from attempting the impossible when they gave the responsibility for single-payer over to a new regulative entity- the Green Mountain Care Board (GMCB). When single-payer failed, the Legislature tried again with OneCare. The signs for OneCare aren’t much more promising, but don’t tell regulator/cheerleader GMCB that.

State auditor Doug Hoffer tried not to completely castigate the concept, when he released a highly critical 70 page report regarding the future of OneCare: “I’m not saying that the model is bad in and of itself, I’m just not convinced that the monitoring and oversight is as rigorous as it needs to be.”

OneCare (an accountable care organization- ACO) was created in 2016 on the premise that changing the way Vermont hospitals and doctors were paid would reduce seemingly perpetual cost increases in healthcare. Medicaid, Medicare and private insurance companies give money to OneCare, which passes along the money to hospitals and doctors in monthly payments, with a non-unsubstantial cut off the top.

OneCare is slowly absorbing Vermont’s entire healthcare infrastructure- 13 of the state’s 14 hospitals now participate in the program. Since OneCare is the only sanctioned ACO in Vermont, it has monopoly power granted by the state. By shutting out any form of potential competition, Vermonters are at the mercy of those regulating OneCare, namely, the Green Mountain Care Board, which verifies OneCare’s certification eligibility each year. Only problem is, the GMCB is hardly an impartial regulator. It has a stake in helping OneCare succeed. Failure on the part of OneCare would mean failure of the GMCB (and the legislature). Perhaps this is why GMCB is dragging its feet on actually performing even the most basic of regulatory functions.

Hoffer questioned why the GMCB hasn’t analyzed the skyrocketing costs of OneCare. In 2020, OneCare had administrative costs of $19 million out of a total budget of $1.43 billion. Kevin Mullin, chair of the GMCB, has insisted the GMCB will get around to considering the administrative costs of OneCare, but only in 2022, when OneCare’s five-year contract with Medicare and Medicaid Services expires. In the meantime, Vermonters are asked to suspend judgement on OneCare.

Hoffer expressed further criticism: “6 of the 22 quality measures in the All-Payer Agreement have baselines… that are either the same or higher than their corresponding 2022 targets. That means quality of care could decline and yet the targets achieved…the public could be misled if the GMCB emphasizes that a target was met without also acknowledging that quality had declined.”

The GMCB’s reluctance to critically examine OneCare suggests that they may already know OneCare is not delivering the savings the legislature and the GMCB promised Vermonters. Perhaps the GMCB is hoping that by 2022, abandoning OneCare will be appear expensive than sticking with a faulty OneCare. Vermonters must insist on what Hoffer has proposed- a more in depth look at OneCare, that examines both cost and quality measures. Before the GMCB can claim “it’s too late to go back now.” To do otherwise is to stubbornly ignore signs that the OneCare/GMCB monopoly will continue to burden Vermonters with low-quality, high-cost healthcare.

David Flemming is a policy analyst at the Ethan Allen Institute.

{ 2 comments… read them below or add one }

dave, MD July 10, 2020 at 10:06 pm

Vermont health care has always been efficient and if GMCB had let the hospitals keep their margins above 3% like in pre GNCB years I can assure hospitals would have more cash on hand to weather this pandemic financial storm


David July 23, 2020 at 1:26 pm

Medicare for all is now proven the cheapest and most healthy way to go. Anything else is absolutely built on greed.


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