by Timothy McQuiston, Vermont Business Magazine OneCare Vermont, a pioneering Accountable Care Organization (ACO) dedicated to improving Vermont’s healthcare system, has announced plans to wind down its operations at the conclusion of 2025. This decision comes as the Vermont All-Payer ACO Model (VTAPM), a state-led initiative designed specifically for Vermont, is set to conclude at the end of the calendar year 2025.
The overhead cost of the program and tangible progress in both health outcomes and cost savings have put the ACO on the defensive the last few years.
This pivotal moment in the region's healthcare reform journey follows nearly a decade of successful collaboration among healthcare providers to improve quality and reduce spending. OneCare said in a statement that with its support, Vermont providers have realized millions in shared savings, enhanced care quality, and have engaged in unprecedented collaborative efforts. The organization has also played a crucial role in stabilizing primary care through its population health programs and Comprehensive Payment Reform (CPR) program for independent primary care practices.
“Together, we have made significant strides in transforming care delivery and payment models,” said Abe Berman, CEO of OneCare Vermont. “Our collective efforts have not only improved the quality of care for Vermonters but have also fostered a supportive environment for primary care providers and others across the care continuum during challenging times.”
In its final operational year, OneCare is committed to supporting its participant network in achieving shared cost and quality goals. The organization intends to maintain consistency for participants during the last year of the Vermont All-Payer Model. All programs, investments, and waivers will operate as previously planned to facilitate a smooth transition as participants explore future opportunities for 2026.
"Throughout a challenging reform environment, OneCare has successfully united providers across the continuum of care to pursue common goals,” commented Anya Rader Wallack, OneCare Board Chair. “This effort built upon a long history of successful Vermont health care reform programs, and I feel confident the foundation we’ve established will serve as a strong basis for future innovations. On behalf of the Board I want to thank the resourceful team at OneCare for their dedication to this important work.”
OneCare has been under pressure over the last few years from the Vermont Auditor of Accounts and the regulatory Green Mountain Care Board to show a return on investment in both health outcomes and budgeting.
The Green Mountain Care Board (GMCB) in December 2023 approved OneCare Vermont’s FY24 budget with modifications directing more resources ($957K) to patient care through population health or primary care programs. GMCB increased the potential for OneCare to earn more federal dollars on behalf of its network through its Medicare program.
The GMCB also required OneCare to cut salaries and benefits, which reduced those costs by $1 million from FY23 to FY24 to $7.2 million, on operational costs of $13.3 million. The total budget, which blends Medicaid funds, hospital fees and insurance payments, was $1.1 billion in FY24.
BlueCross dropped out of participation with OneCare at the end of 2022 “due to the lack of tangible quality outcomes, inability to bend the cost curve, and the new data approach that introduces concerns about security and privacy.”
In June 2021, Auditor of Accounts Doug Hoffer released a scathing audit of the ACO.
The auditor looked at the financial performance of OneCare through 2019. The analysis found that the collective performance of OneCare was a minus $25.6 million. This was largely attributed to both OneCare missing its financial targets ($11.1 million) on the one side and the amount of money the state put into it ($14.5 million) on the other.
“Every Vermonter knows that health care costs are too high, and that they are growing too quickly,” said Auditor Hoffer at the time. “Those watching closely will have heard this often – ‘we need to move away from fee-for-service health care that rewards health professionals for the number of procedures they perform and toward value-based care that pays them to keep us healthy.’ That’s what the All-Payer Model is about. But even the best initiatives are only as good as their implementation. It must save Vermonters money and make them healthier.
“The report I’m releasing today looks at the financial performance to date. I would have liked to be able to audit both the financial and the health performance, but there just isn’t the data on the health side at this time.”
The key finding of the audit was that OneCare, the Accountable Care Organization at the heart of the model, missed its Medicaid financial targets for 2017 through 2019 by a combined $11.1 million. During those same years the State also paid for $14.5 million of OneCare’s operating costs. When including the operating costs, OneCare’s estimated net Medicaid financial performance for those years collectively is -$25.6 million.
"Put simply," Hoffer said, "at this time the financial costs to run the model significantly exceed any Medicaid savings attributed to it."
Earlier in 2021, Attorney General TJ Donovan filed a lawsuit on behalf of State Auditor Doug Hoffer against OneCare Vermont after the ACO breached its contract with the State by repeatedly refusing to provide accounting records to the State Auditor.
Hoffer had requested records from OneCare to ensure that Vermont tax dollars are being efficiently used, but OneCare has repeatedly refused his requests.
Instead, the organization released its 2019 compensation information for officers, key employees, and the five highest compensated employees
to the Green Mountain Care Board—accounting for only 12 of its more than 61 employees.
Vicki Loner, the OneCare CEO at the time, said in response: “OneCare has met our contractual obligations and we don’t understand why the Auditor believes he is entitled to the personal financial information of each and every one of our employees, including their W-2 and 1099 forms. We feel compelled to oppose this intrusive and unnecessary request.”
She added that if the Auditor’s argument about the meaning of the mandatory standard state contractual provisions were correct, he would be entitled to ask for the salary of every employee of nearly every business that has signed a contract with the state of Vermont.
Overall health care costs and insurance premiums have accelerated over the last 20 years. A consultant's report (Oliver Wyman) released in October 2024 suggested that the state needs to overhaul its entire hospital system or face dire financial consequences.
OneCare is an accountable care organization that partners with local health care providers to transform Vermont’s health care system to one that focuses on health goals, by providing actionable data and innovative payments that foster better health outcomes for all. OneCare establishes value-based care contracts with insurance payers (Medicaid, Medicare, and commercial insurers) on behalf of over 5,000 participating providers from the full continuum of care, including primary care, specialists, hospitals, designated agencies, home health, and long-term care providers. By supporting providers, increasing access to preventative care, and paying for value and health outcomes rather than various services, such as tests and operations, this value-based system will keep Vermonters healthier and help control health care spending growth.
Source: 11.6.2024. Colchester - OneCare Vermont
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