A key player in health care payment reform in Vermont announced it will shut down by the end of 2025.
OneCare Vermont allowed hospitals, independent practices, home health agencies, and other providers to collaborate by sharing financial information and other data. And they provided monthly payments to more than a dozen independent primary care practices for quality outcomes, which gave those practices an additional revenue stream on top of billing for individual services, called a “fee-for-service” model.
The organization was also an expensive player in the state’s health care system — hospitals and state agencies paid millions of dollars each year to support OneCare, which had close to 40 employees. It’s unclear whether the nonprofit’s work resulted in commensurate savings, according to a report this year from the Green Mountain Care Board.
“I think we tried to, perhaps, be too many things to too many people,” said Abe Berman, the CEO of OneCare, in an interview last week.
OneCare launched in 2016 as an experiment in how the state pays for health care by encouraging insurance companies and federal health insurance programs to compensate providers for quality measures, known as an “all-payer model.”
“It became a little bit of a panacea,” Berman said. “It was going to cure every ill in the system — and we know that’s not really how interventions work.”
The monthly payments that OneCare provide to some primary care practices help support patient services, like mental health care, care coordination, and other wrap-around services. After next year, those payments will go away.
“We are worried we are not going to be able to sustain that level of services for our patients,” said Dr. Toby Sadkin, a clinician at Primary Care Health Partners, a group with 10 offices in Vermont that covers thousands of patients throughout the state. Sadkin is also a member of OneCare's board of managers.
“Another financial piece of it — and honestly this is so new that I really don’t know — but I worry about some of our practices. I worry that some of them might not actually be able to continue,” she said.
I worry about some of our practices. I worry that some of them might not actually be able to continue.Dr. Toby Sadkin of Primary Care Health Partners
Owen Foster, with the Green Mountain Care Board, acknowledges that the end of OneCare will be a loss to some practices. But he says it was not a very efficient system.
“To get the money to primary care providers, we had a very expensive middleman, which was OneCare,” he said. “Money had to go from the hospitals to OneCare dues, out of OneCare, to individual primary care practices. That's not a great way to pay for health care.”
He says throughout the tenure of the organization, health care payment in Vermont did not fundamentally shift away from the “fee for service” model. That was especially true a few years ago, after a big commercial insurer, BlueCross BlueShield of Vermont, stopped working with OneCare.
The state is currently in negotiations with the federal government to participate in another payment reform program called the AHEAD model, which would start in 2026, if Vermont decides to take part.
“This is the only opportunity, really, to bring additional Medicare dollars and federal dollars to support primary care in Vermont,” said Jessa Barnard, the head of the Vermont Medical Society.
It’s would also be a continuation of a value-based payment system that started with OneCare.
“If we’re not doing AHEAD, it really does all go away,” Barnard said.
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