Blue Cross Blue Shield of Vermont issued a press release on Dec. 20, 2022, announcing it would forego its 2023 participation in OneCare Vermont, the state's sole Accountable Care Organization.
We commend Blue Cross for this necessary step and for its candid assessment of OneCare's fundamental shortcomings. The state's largest commercial insurer will pull nearly 93,000 members from OneCare, almost one-third of the ACO's population, "due to the lack of tangible quality outcomes, [OCV's] inability to bend the cost curve, and [OCV's] new data approach that introduces concerns about security and privacy."
This is a timely and potentially pathbreaking admission. Gov. Phil Scott, Human Services Secretary Jenney Samuelson, healthcare regulators and legislators should take heed and change course.
After expending more than $80 million on administrative overhead since its inception six years ago, OneCare has not improved the quality of care, broadened access to essential services, or lowered costs for Vermonters. Spending millions more on OneCare, therefore, as proposed in its 2023 budget submission, makes no sense. In fact, OneCare's leadership asserted recently that the ACO was just a "pass-through" organization. Why should Vermonters pay for this administrative function?
In addition to Blue Cross's decision, we commend the Green Mountain Care Board for its more assertive approach in determining whether OneCare has made material progress commensurate with its mission and costs. We are also heartened by the Board's insistence that healthcare affordability must be a central focus of reform efforts moving forward.
There is a profound crisis in Vermont's health care, and it is systemic. Many Vermonters cannot afford to go to the doctor; they are shut out of care by soaring premiums and prescription costs, high deductibles, acute shortages of primary care physicians and other community-based providers, and long wait times. Primary care physicians, mental health counselors, home health caregivers and nurses desperately need more financial support and programmatic resources to serve and protect us. They are, and always will be, the backbone of a high-functioning, compassionate healthcare system, and we must come to their aid.
To Governor Scott, we respectfully ask that you retract your offer to help negotiate new terms between OneCare and Blue Cross. Instead, invite working Vermonters, patients, reform advocates, and community-based health care providers to "your table." Hear directly from them what is needed to rebuild and revitalize our health care system, sharply reduce costs, budget rationally and sustainably for hospital services, and ensure equitable access to high-quality care for all Vermonters.
In state policy and regulatory forums, and with the Centers for Medicare and Medicaid Services, it's time to declare that the experiment called OneCare Vermont is over, then act decisively on that conviction.
Don Tinney, president, Vermont-National Education Association; Steve Howard, executive director, Vermont State Employees Association; Deb Snell, president, AFT Vermont Health Care; Paul Burns, executive director, Vermont Public Interest Research Group; Lindsey Owen, executive director, Disability Rights Vermont; Bill Schubart, former board chairperson, Fletcher Allen Health Care; Betty Keller, MD, president, Vermont Physicians for a National Health Program; Deb Richter, MD, president, Vermont Health Care for All; Jack Mayer, MD, MPH, Rainbow Pediatrics; Johanna Brakeley, MD/developmental behavioral pediatrician (retired); Sue Racanelli, executive director, League of Women Voters in Vermont; Julie Wasserman, MPH; Patrick Flood, former Deputy Secretary of the Agency of Human Services.