$779 Million Experiment Looks To Change Health Care In Vermont

Jun 30, 2017

OneCare Vermont, one of the newest players in the Vermont health care industry, has submitted its first budget to state regulators – and its CEO says the nearly $800 million proposal will change the way medical care is delivered in the future.

The nonprofit company is what's known in health care parlance as an "accountable care organization." OneCare will serve as a kind of bureaucratic glue that binds hospitals, doctors, nursing homes and other providers. It's seeking $779 million to take care of 137,000 patients next year.

It's part of a high-cost experiment in medical reform that's designed to get expenses under control by coming up with more effective treatment models for individual patients.

"Our job is really not to be the story, and not to set those models, but to create an environment of incentives and support and capabilities that allow these communities and their providers to succeed," says Todd Moore, CEO of OneCare.

OneCare is a 47-employee organization, housed in the third floor of an unremarkable office building in an industrial park in Colchester. The company has kept a pretty low profile since it was launched about two years ago.

But earlier this week, after submitting his 2018 budget request to state regulators, Moore invited members of the media for a briefing on what he thinks this new venture will mean for patients.

"We want to have a game plan for every single one of them that coordinates a fragmented system and meets their needs," Moore says.

Todd Moore, CEO of OneCare Vermont, is pictured here at a media briefing in Colchester on Tuesday. Moore says his accountable care organization can reduce health care costs and improve patient outcomes.
Credit Peter Hirschfeld / VPR

OneCare includes eight hospitals, 29 primary care practices and three federally qualified health centers, as well as nursing homes and community mental health clinics.

It hopes to change the way patients are cared for by changing the way providers get paid.

Mark Depman is the director of the emergency department at Central Vermont Medical Center, which is part of the accountable care organization. Here's how he describes the life of ER doctors under the existing payment structure:

"They're highly incentivized to see patients, treat them, get them out. Rack up as many charges as you can. In their jargon, 'You treat 'em and street 'em,'" Depman says.

Under the accountable care organization, Depman says, that all changes. OneCare and its member providers will get a lump sum payment to provide care for 137,000 patients for a calendar year. If they exceed their budget, they suffer financial consequences. If they stay under, they reap the rewards.

OneCare and its member providers will get a lump sum payment to provide care for 137,000 patients for a calendar year. If they exceed their budget, they suffer financial consequences. If they stay under, they reap the rewards.

That means doctors like Depman, and hospitals like Central Vermont Medical Center, suddenly have a vested stake in minimizing their patients' health care expenses.

The best way to do that, Depman says, is by helping them live healthier lives. He recounts the story of an 87-year-old woman that recently arrived at CVMC.

"She had pneumonia, she had sepsis. She was going to be admitted to our intensive care unit for days," Depman says.

The woman lives in a rural hollow on the outskirts of CVMC's coverage area, and was found inside her home by neighbors who'd heard her dog barking outside.

Depman says that under the accountable care organization model, his department is encouraged to diagnose and treat not only the symptoms that landed the woman in the ER, but the circumstances that led up to it.

"Her social isolation, her isolation from transportation, her food insecurity," Depman says. "If we don't get that team together right then, we're not going be able to make a difference in where she is six months from now, a year from now."

Depman says OneCare will provide the financial resources and organizational capacity to create those provider teams, and also bring the big-data analytical power to determine which interventions are working, and which ones are not.

Mike Fisher is the chief of the Office of the Health Care Advocate, a consumer protection group funded by the state. Fisher says it's a promising model, but Fisher also says anytime providers have a financial incentive to keep costs down, regulators and consumer advocates need to be vigilant.

"We have to keep a really close eye on quality measures, on making sure that there are quality measures in place that measure patient satisfaction," Fisher says.

Moore says provider compensation under this new model is tied directly to a laundry list of patient health indicators. And Moore says he thinks hospitals can deliver better outcomes, and lower costs, at the same time.