Report finds Vt. health care reform efforts showing promise

Published: Sep. 7, 2021 at 4:45 PM EDT
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COLCHESTER, Vt. (WCAX) -- A new independent report shows “promising” results in Vermont’s health care reform efforts. It says that the all-payer model, which aims to cut health care costs and keep people out of the emergency room, is paying off.

The 91-page report by the nonpartisan NORC at the University of Chicago, paints an encouraging picture of Vermont’s reform efforts.

“I think this is a huge deal for all-payer, in that it’s showing that it does have promise,” said Vicki Loner, the CEO of OneCare Vermont, the Accountable Care Organization made up of hospitals and providers participating in the all-payer model.

It shows big Medicare cost savings for the first two years -- about $600 annually per patient -- and a decline in the number of patients seeking acute hospital care.

“Those things are starting to say, focusing on the patient’s health -- the total health of the patient -- is the way to go,” said Vt. Agency of Human Services Secretary Mike Smith.

Most importantly, Loner says it all happened without trading off health care quality. “We have received a lot of criticism along the way. This is the first third-party analysis of the all-payer model,” she said.

At least some of that criticism has come from a former employee. Robert Hoffman sued OneCare three years ago accusing them of fraud, but the case never gained traction and he withdrew it. After reading the new report, Hoffman questions where the savings came from. “NORC never establishes that the $122 million in savings wasn’t caused by limiting access to care,” he said.

Reporter Calvin Culter: “Given some of the reports we’ve seen about long wait times at hospitals, do you think any of this could be contributing to care rationing?”

Vicki Loner: “The ACO model is structured to make sure that along the way those within the ACO (Accountable Care Organization) are monitoring key performance issues such as low utilization than what you would normally see on key services. If you happen to see them, digging a little deeper to understand why there may be that variance. Is that something that’s happening across the country or something that’s happening with the ACO.”

Loner also says the wait time issue is more likely due to other issues such as staffing shortages at hospitals - something she says is beyond the framework of payment reform.

The NORC report also showed that annual well-visits, a critical component of keeping Vermonters healthy and growing the all-payer model - were down 43 percent within the Medicare population.

OneCare staff suspects that the dip in well-visits could have to do with inconsistencies in billing coding, as some providers use different systems. OneCare Vermont Communications Manager Alida Duncan also says an incentive for Medicare patients to receive a cash bonus if they sought regular primary care visits was turned off by CMS (Centers for Medicare & Medicaid) in 2019.

“The report also points to, in the second performance year, an increase in primary care evaluation and management codes, which may focus on care coordination,” Duncan said in an email to WCAX. “The bottom line is that utilization of these wellness codes did not lead to any conclusions on quality or access to care.”

For all-payer to work, every provider serving every Vermonter needs to sign on. That hasn’t happened yet. Officials say 67,000 people were added last year, plus some 13,000 state employees this year.

Smith says this new report shows Vermont is on the right path, but also says that more work needs to be done in engaging commercial insurance providers into the all-payer model. “I think the commitment is there to make sure we change how we care for people and how we finance care, and that we finance care based on keeping someone healthy,” he said.

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