Primary Care is the foundational to Vermont’s all payer model. Yet, in the middle of a pandemic with primary care practices struggling to survive, OneCare Vermont has chosen to reduce payments to these practices.

OneCare is Vermont’s sole accountable care organization and as such exercises influence over the system. OneCare recently decided to decrease upfront payments to primary care physicians from $3.25 per patient per month to a base of $1.75. This new ACO payment ladder has the potential to rise to $4.75. However, primary care physicians can ill afford to receive a lower initial payment and then wait over a year for the “bonus” payment. This change in payment rates raises a variety of critical questions:

  • Is OneCare hoping to weaken independent primary care practices in order to leverage buyouts?
  • Do we want to put primary care physicians “at risk” when so much of health care spending is out of their control?
  • Why has the ACO overlooked the costly expenditures related to specialists and specialty care?
  • Do we want to continue shifting control of Vermont’s health care system to OneCare, a private for-profit entity whose payment policies undermine primary care when its expansion and enhancement are so desperately needed?
  • Why has the Green Mountain Care Board remained silent?

Let me count the ways this new payment policy is a retreat from the goals of the all payer model.

How was OneCare’s new payment plan developed? Successful plans affecting the “coalition of the willing” require collaboration and coordination. Did OneCare collaborate with the primary care practices in developing this new payment plan? Did OneCare provide statistics on how primary care practices might fare with gains or losses under this new approach using quality metric data? Rather, OneCare made a unilateral decision that clearly imperils many of the state’s independent primary care practices, thereby making them vulnerable to acquisition. continue reading