Just when you thought the all-payer model and ACO could not get any stranger, there is a new and shocking development. Recently, the Green Mountain Care Board released the 2020 financial and quality care results for OneCare Vermont. The results show OneCare “saved” almost $8 million in Medicare spending and over $15 million in Medicaid spending.
No one believes OneCare operated so efficiently that it produced those savings. Those savings result from the effect of COVID-19. In 2020, because of COVID, people and providers postponed care. Nonetheless, because of the way the contract is written, Medicare and Medicaid spent less than was budgeted, therefore the state and federal government must pay the difference to OneCare. It is outrageous that taxpayer money is being paid out to a private entity for actually doing less.
To make matters worse, in 2020, OneCare’s scores on quality-of-care measures, such as blood pressure and diabetes management, declined. For OneCare’s quality performance in Medicare, half of the measures had worse outcomes. In 6 out of 12 measures, OneCare’s performance declined from the prior year. For Medicaid, OneCare’s performance declined in 9 of the 10 measures, compared to the prior year. So, the state and taxpayers are paying OneCare $23 million for not only less care, but lower quality care.
This makes no sense. When the state cannot find funding to address homeless services or child care, and when many Vermonters struggle to pay for health care, it is gross mismanagement to pay a private entity that amount of money for doing less and doing it badly.
Since it appears the Scott administration is committed to the current failing model, legislators need to assert themselves to protect Vermonters and taxpayer money by putting an end to this experiment. It is long past time to re-direct our focus to real health reform that will actually help Vermonters, not defraud them.