Can Vermont's 'all-payer' health care model deliver on its promises?

Published: Dec. 20, 2019 at 2:09 PM EST
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What if you saw your doctor more often, stayed healthier and paid less for your health insurance? That's the promise of Vermont's move toward an "all-payer" health care system. In part two of his investigation, Our Calvin Cutler has been exploring how Vermont health care providers are trying to deliver on that promise.

Back in 2010, the Affordable Care Act -- also known as Obamacare -- essentially created a tool that lets hospitals, doctors and providers team up as a network to share resources that's called an Accountable Care Organization. Vermont's ACO is called OneCare Vermont, and the for-profit company now oversees the care of 175,000 Vermonters. One of them, a woman in Franklin County, says the new system is changing how she stays healthy.

Marie Bessette has lived in Saint Albans just about her whole life -- nowadays with her husband and two dogs.

She was diagnosed with diabetes in 2012. "So as time went on it was getting worse and worse, creeping up. I knew it. I was tired all the time, I was thirsty all the time. I knew it wasn't getting any better. Every time I went to the doctors we'd check it and they'd be like 'Well, you need to lose weight,'" Bessette said.

On average, treating and medicating diabetes costs around $10,000 a year -- mostly for hospitalizations and prescription drugs. OneCare Vermont, the organization tasked with rolling out the state's experimental "all-payer" system, is looking to reduce those costs. OneCare has pulled together a network of medical professionals focused on the overall health of each patient.

"When I think about the work we do here at OneCare, it's really thousands of providers from across the state, home health care, physicians, nurse practitioners, specialists, that have come together and said, 'we want to share resources and share expertise,'" said Vicki Loner, OneCare's CEO.

Under OneCare, Bessette now has access to monthly group diabetes workshops where she shares her lifestyle, eating habits and exercise routine. By working with doctors, nutritionists and other diabetes patients, Bessette says she feels more accountable for her health.

"I probably wouldn't have gotten that feeling having just gone for a regular appointment. It would have been, 'Well, I'm doing okay. I have this problem.' 'OK, well try this,' and boom, you're out," Bessette said.

Dr. Toby Sadkin, Bessette's primary care provider, runs the diabetes group and says programs like these through OneCare aim to promote healthy living and staying on top of chronic medical conditions by reducing the need for expensive acute care. She also says because her practice is part of the OneCare network, patients like Bessette get access to other resources in the community.

"We're able to go through this whole team, we're able to access other social services, other community services. There's a whole team helping to support the patient and helping to help them to get more engaged in their health care and become healthier and help themselves better," Sadkin said.

Since there are several people in Bessette's diabetes group, this lets Sadkin treat several people at once, saving time and money, and that allows her to see more patients more frequently.

"You would do things like telemedicine or have a phone call with a patient instead of having them come into the office. There's so much flexibility that's offered under this model, it really is tailored to meet the needs of Vermonters," Loner said.

Under OneCare, providers no longer bill for each service they provide. Instead, they get paid a flat fee based on each patient's relative health.

"It takes into account if individuals have higher resource needs so that the practice can make sure they get all the care and services they need in their offices," Loner said.

She says OneCare is already helping reduce costs for Medicare and Medicaid patients but has yet to produce savings in the private insurance market. Critics have questioned whether those savings will materialize and have taken aim at the internal operations of at the for-profit company. Loner insists that the model is working, but says measuring the success of OneCare will take time.

"I would say that it's going to take some time to see those changes, and being part of the movement and being part of the solution will be really important and just giving it some time to work," Loner said.

For Bessette, her focus is staying active, eating healthy and keeping her blood sugar down to stay on top of her diabetes. By attending the diabetes group, checking her vitals at home and working with her care team, she says it's helping her stay healthy. "I would say I've changed my lifestyle in, I'm more conscious of what I'm eating -- I read labels all the time. How many carbs does this have, how much sodium does this have? I wouldn't have done that before," she said.

OneCare Vermont is asking lawmakers this session for approval of about $13 million. About $4 million of that will come from Vermont taxpayers and will be used to increase access to health care, chronic care management, and suicide prevention.