Vermont officials roll out all-payer health care reboot plan

BURLINGTON, Vt. (WCAX) - Vermont officials Thursday presented their long-awaited reboot of the state’s experimental all-payer health care model.

The all-payer model, a four-year multibillion-dollar effort to rein in costs and improve services, is not moving as quickly as hoped, mostly because not enough health care providers have opted to join and bring their patients into the system. OneCare Vermont, the organization that runs the program, was supposed to have 58% of Vermonters on board, but so far only 42% have signed up.

Now, state leaders are doubling down on the reform efforts with an improvement plan. “Fee-for-service is perverse in so many ways. It incentivizes you to perform more procedures, it incentivizes you to perform more costs,” said Vermont Agency of Human Services Secretary Mike Smith.

The changes aim to bring more transparency by having OneCare provide data to show the public -- and providers -- the benefits of the all-payer model. “They need to understand how to transform care in order to improve,” said Ena Backus, Vermont’s director of health care reform.

The plan calls on the federal government to recognize Medicare payments and for the state to have conversations with hesitant providers. The state is also trying to get more groups on board, like the 9,000 strong Vermont State Employees Association. The deal with the union still has to go through the collective bargaining process, and VSEA executive director Steve Howard says the union is proceeding cautiously. “There are so many forces out there that have ideas about what and how our health care plans should operate. We don’t want to do anything that diminishes services,” he said.

Ultimately, changing how money flows from patients to insurance companies to doctors requires a big shift in how we imagine health care. Smith says fee-for-service is unsustainable and the all-payer model is the future. “I don’t think it’s a question of if it’s coming. It’s how it’s coming and how fast it’s coming,” he said.

As part of the plan, state leaders will also report back to the public four times a year so people can actually see if the model is working.

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