Anya Rader Wallack: OneCare Vermont Is Improving Quality Of Care, Reducing Costs

OneCare Vermont is improving the health of Vermonters and lowering the cost of health care.

OneCare is an Accountable Care Organization (ACO). We partner with health insurance companies, hospitals, independent medical practices, community health organizations and community collaborators to improve the quality of health care and make it more affordable for Vermonters. OneCare is an important piece of the health care reform puzzle.

OneCare is working. OneCare is improving the quality of care and reducing costs in Vermont.

A primary goal of health care reform in Vermont has been to move health care spending away from the fee for service model, which is how most health care is paid for in the United States. Fee for service means paying for specific services, such as visits, operations or tests on an individual basis. This model is, in large part, responsible for the unsustainable growth in health care costs in the US.

In place of fee for service Vermont health care reform aims to move toward a value-based payment model, which prioritizes and compensates providers based on health outcomes rather than services. In other words, providers are paid for making patients healthy instead of being paid to perform specific services like running tests and operations. OneCare has been the main vehicle for meeting this goal. OneCare was established to manage the transition to value based payments and manage the payment model once implemented.

OneCare has made significant progress toward its goal by holding more than 5,000 Vermont health care providers responsible for the cost and quality of the care they provide through payment contracts. Indeed, between 30 and 40 percent of Vermont residents will receive care that is partially linked to outcomes-based payments in 2023.

OneCare also makes available support services to providers so that they can reduce costs and improve quality. These services include providing data to help identify which Vermonters need outreach and where areas of care need to improve; funding primary care providers with predictable monthly payments; delivering on waivers from rules that get in the way of high-quality patient care; and supporting higher quality care through prevention efforts.

And, again, it's working. Through this work OneCare has been improving the quality of Vermonter's health care while reducing costs. Specifically, OneCare's results include:

* Significant health care savings. Savings for Medicare of over $50 million have been realized since 2018.

* Lower costs. Vermont has been able to reduce high-cost services such as inpatient and emergency room visits as well as overall Medicaid cost growth. OneCare achieved Medicare gross spending reductions in all years it was evaluated by the federal government.

* Stabilized access to primary care. Due to the predictable monthly funding from OneCare, Vermonters have maintained access to primary care, the heart of a better model for care delivery. Primary Care Health Partners, the largest employer of independent primary care physicians in Vermont, recently wrote, "Had it not been for the [OneCare's] Comprehensive Payment Reform Program (CPR), it is likely several of our practices would not exist today…We believe OneCare's CPR program has been one of the greatest innovative care models aimed at preserving independent primary care in the state."

* High quality. OneCare's providers have consistently scored above average on quality of care. For example, in 2021 OneCare providers scored in the 90th percentile nationally for diabetes management.

* Stakeholder support. OneCare provides an important, unifying forum for providers, payers, and the state to engage in meaningful discussions about healthcare reform and set goals. The model is also strengthening relationships among a variety of providers, which has proven to be critical during the pandemic.

Overall, providers in OneCare are delivering higher quality care and more savings. Reforming the health care system is imperative and we are making progress. While health care reform isn't simple and isn't going to happen overnight, OneCare's efforts to improve the quality of health care and lower costs is a giant step in the right direction.

Anya Rader Wallack, PhD, is chair of OneCare Vermont Board of Managers.