OneCare Vermont Has Increased Costs While Decreasing Health

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OneCare Vermont is an embarrassing disgrace, if not for its obvious failures then for its evasion of accountability. The stated purpose of this massive administrative money-spender was to save money and improve healthcare for Vermonters. Instead it appears to be a money-sucking disgrace that rewards a handful of bureaucrats at the expense of both public health and public coffers. This financial health experiment is a failure, and the money would have been much better used to fund the anemic state pensions system, or to improve mental health services.

OneCare Vermont was an experiment purporting to protect Vermonters. The accountable care organization gets funds from Medicare, Medicare and private insurers and then pays out those funds to doctors and hospitals. Doctors in the system are paid an annual set fee per patient, instead of for each procedure or visit. The funding strategy aims to promote more preventive care.

But health care costs have skyrocketed. OneCare Vermont employees are paid nearly twice what comparable organizations earn, hospitals are being fiscally destroyed, and patient care is dropping as bureaucrats displace doctors and nurses. Vermont’s mental health services are in ruin, as well as its pensions. Meanwhile, OneCare Vermont resists even an accounting of where it has spent this taxpayer money.

OneCare Vermont set out to change how health care is paid for in Vermont, yet State Auditor Doug Hoffer has attempted to obtain access to OneCare Vermont’s records through a bill never passed. Hoffer concluded that “OneCare has cost the state $25.6 million more than what it would have paid under the fee-for-service Medicaid model” and deemed $12.7 million to be “unaccountable expenditures.”

OneCare Vermont also appears to be more costly in lost lives and hospital solvency. Robert Hoffman, a former OneCare Vermont analytics team data manager, in 2019 raised alarms over alleged fraudulent reporting and wasted money, to no avail. Mr. Hoffman now serves as an adjunct professor at Chestnut Hill College, and has claimed that OneCare Vermont has placed Primary Care Providers (PCPs) at financial risk while its executive leadership is “gratuitously overpaid,” far exceeding comparable salaries nationally.

Mr. Hoffman’s analysis, and Auditor Doug Hoffer’s loud complaints, are apparently ignored by the Legislature, which has not demanded accountability from OneCare Vermont for its spending, its exorbitant salaries, its lack of transparency, its failure to openly provide records, or its efficacy in actually improving healthcare outcomes. Yet according to Hoffman, this experimental administrative trainwreck may have cost an additional 320 Vermonters their very lives.

Mr. Hoffer cites figures for 2013-2018 that “demonstrated mixed health results at best,” concluding that “the entire population shifted to higher morbidity,” and that “VT’s age adjusted 45–64-year-old mortality rate was 3.7x the national average. He claims that from 2014-2020:

Vermont’s mortality growth rate outpaced the national average. Sadly, 320 additional lives above national growth rates were lost. Those are not increased deaths for Covid-19 above in 2020, as only 10 aged 45–64-year-old Vermonters died thereof. Instead, they are the 3.7x greater loss of life than national average for the CDC leading causes of death that Vermont was specifically tasked with focusing on preventative care for – such as diabetes and heart disease.

OneCare Vermont was touted as life- and money-saving by Anya Rader Wallack, who benefited greatly in salary while claiming this new scheme was no scam. Wallack said:

“I believe the American health care system is in crisis and can only be fixed by people who have a clear vision for reform and are in a position to improve it. I have dedicated my professional life to improving our health care system and keeping it affordable.”

But the numbers say otherwise, and numbers (not being paid millions of sick Vermonters’ money) don’t lie. It is clear that healthcare premiums have skyrocketed and hospital incomes have declined — while bureaucrats at OneCare Vermont saw their financial health far outstrip both. Stripping away the falsehoods and obfuscation, it is clear that this system needs to go: it costs taxpayers about $40 million annually that would be better invested in the crumbling state pensions. According to Green Mountain Care Board’s own numbers, this system cost $229,630,580 from 2017-2022.

Vermont’s local hospitals are in fiscal crisis, patient care has declined while paperwork and red tape have proliferated, the state is experiencing a chronic nursing shortage and dearth of mental health care facilities, and more people are dying than under the prior system. Those who designed (and continue to inflict) this experimental system should have their heads — and their bank accounts — examined, to spare Vermonters yet more pain.

As Mr. Hoffman concludes: “Instead of serving as a model, Vermont should serve as a cautionary tale for the risk to life [which] well-intentioned reform efforts create in the form of second order effects.”

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