Health care reform up in flames. Anyone care?

In 2011, Gov. Peter Shumlin signed into law Act 48, which set into place 14 principles in Vermont's march to reform its health care system. The principles were basic and oriented around the established needs to provide high quality care, at affordable prices, to all Vermonters.

One of the principles - #13 - was the need for a "partnership between consumers, employers, health care professionals, hospitals and the state and federal government." It was understood that success would require working together, putting aside individual interests.

Today, that "partnership" lies in tatters. On the "working together" front, we're failing. The open question is whether Vermont's plan for health care reform is salvageable.

The latest blow came last week when BlueCrossBlueShield [BCBS], the state's largest insurer, made the surprise announcement that it was pulling out of its contract with OneCare Vermont, the state's Accountable Care Organization, which, among other things, operates the state's "all-payer" reform program.

The insurer had not communicated with OneCare that it intended to pull out before the contract took effect, which was January 1, 2023. OneCare officials were "shocked." The differences were issues that could have been resolved, given the chance. The insurance company chose not to.

The insurance company also took a gratuitous shot at OneCare saying it was also concerned about OneCare's "lack of tangible quality outcomes" and its "inability to bend the cost curve." The insurer was repeating the same question raised by several members of the Green Mountain Care Board who recently asked OneCare officials to defend themselves, to show the board how its multi-million budget was benefiting Vermonters.

Fair question.

OneCare officials opted not to respond.

To say that's unfortunate is an understatement. There have been three recent federal audits of OneCare's performance this year, the latest came earlier this month from NORC at the University of Chicago. All three reports noted the progress being made, specifically related to outcomes and lower costs.

The federal government, specifically the Centers for Medicare and Medicaid Services, actually designed the Vermont All-Payer ACO model. The federal government wants to know whether the model can be scaled to a level that would be useful elsewhere. One of the reasons they picked Vermont was because of its experience with health care reform and its willingness to explore new ideas.

But the health care profession is complicated. Health care reform is hard to explain and it's easy for skeptics, or those opposed, to distort the information. The health care profession - writ large - is also little more than a collection of self-interested bodies.

Which partially explains BCBS's decision to pull out of OneCare. The company prefers the status quo. The company knows how to make money under the existing system, whereas payment reform poses an existential threat. BCBS saw its opening when the GMCB raised questions about OneCare's performance and its inability to defend itself. It made OneCare look weak. BCBS pounced.

OneCare has a story to tell. It just doesn't tell it. It doesn't have the means or the leadership to advocate for itself. OneCare's weakness, paired with the effects of the pandemic, puts Vermont's health care reform efforts in jeopardy.

The consequences of a continued decline are real. Primary care doctors could find themselves cut out of the government's revenue stream. Health care prevention efforts could wither. We could easily find ourselves back with a system that values volume over value. We could end up right where we began in 2011.

But would the masses rise in protest? Would there be a sense of loss?

Probably not. But not because the failures were not real, but because the "plan" was never fully explained. The expected bumbs along the way were never defended. We were conditioned to think that payment reform was something that could be done, and done with dispatch.

It cannot.

There are a number of reasons why we are where we are, but the overriding reason is a lack of leadership.

This lack of leadership has allowed the various parties to make their own rules with little fear of being challenged. That lack of leadership is what puts the current reform efforts deeply at risk.

To Vermonters, that is unacceptable. And, frankly, an outrage. Health care represents 20 percent of the state's economy. All 630,000 of us depend on the system for our health. And we all pay dearly for that benefit.

Why do we allow something of such importance to be ignored by those who lead us and those in charge of the various parts of the system?

We shouldn't. Gov. Phil Scott should call the University of Vermont Health Network, BCBS, and OneCare back to the table. He should tell them to shut the door behind them until they figure things out.

Mr. Scott should then assess the leadership strengths of those involved organizations and strongly suggest they find the leadership necessary to move Vermont's all-payer model forward.

There is no Plan B. It's time to act accordingly.

by Emerson Lynn