ACO and All Payer Not About Access

February 10, 2018

St. Albans Messenger

The St. Alban’s Messenger February 7th editorial asks why Vermont needs the proposed new universal primary care system envisioned in senate bill S53. This bill would make primary care a public good for all Vermonters, with no out of pocket costs. It is not expensive. Unlike tertiary care, primary care comprises under 6% of total health care spending. But, investing in primary care actually saves lives and money. Currently, many people delay going to the doctor until they are seriously ill – more expensive to treat and suffering needlessly – because out of pocket costs deter them from seeking timely care.

The editorial asks, however, why we would need this system given that Vermont has already embarked on an all-payer model under the auspices of the Accountable Care Organization OneCare Vermont. It states, “The purpose of the initiative is to shift from a fee-for-service model to one based on per capita care. It’s outcomes based. To make this work means a shift in focus to prevention, which also depends on early intervention, which depends on better primary care services.”

So, why propose a universal primary care system if we have this new all-payer model? The reason is simple. If patients do not go to the doctor in the first place, because they have high out of pocket costs, then neither OneCare or the All Payer Model can improve their quality of care. After all, no care at all is not quality of care.

Simply stated, the All Payer Model and the ACO are about coordination of care and how providersare to be reimbursed, not about access to care
in the first place.

Without Universal Primary Care, these other initiatives are unlikely to succeed in their stated goals of improved health care and contained costs. Studies across the world have shown that universal access, starting with universal access to primary care, is essential for better public health outcomes and cost containment. We have a bill in our legislature now that would make this a reality for Vermont. We should support this – it will more than pay for itself in saved money, saved lives and reduction in unnecessary suffering.

Ellen Oxfeld