“The state’s accountable care organization produced no evidence of results from some of the community health programs it invested in, according to an analysis from the state auditor’s office.”

That was the lead paragraph of a Vermont Digger story on OneCare and the effort of State Auditor Doug Hoffer to audit what OneCare does, and how.

Vermont Digger’s lead paragraph was misleading, to say the least. Mr. Hoffer’s concerns, expressed in a memo to the Green Mountain Care Board, dealt with OneCare’s lack of “robust” efforts to detail its participation in various community health programs across the state. Mr. Hoffer made the point that absent the necessary information it would be impossible to judge any of the programs’ effectiveness.

What Mr. Hoffer did not do was to say OneCare failed to show that its participation in community health programs produced results.

The reason this distinction matters is because OneCare’s purpose is being twisted beyond recognition. It’s being portrayed as a company with a $1.36 billion budget, yet more than 98 percent of that “budget” is pass through money to the state’s hospitals, who are OneCare’s partners. It’s being reported that OneCare’s job centers around health care prevention, but has nothing to show for it. Yet, the company hasn’t been in existence long enough to show any results.

Readers who are not well versed in OneCare’s reason to exist would have little option but to conclude that the organization’s purpose is flawed, that we’re throwing good money after bad. That’s the information they are being fed.

Part of that responsibility falls to OneCare and its health care partners. They haven’t told their story. They haven’t explained the importance of the payment reform system it represents. They’ve not made the case that the only long term way to reduce health care costs is through reduced usage, which involves prevention, which means revamping how we pay for our health care. It also means coaching patience.

OneCare’s primary objective is to switch from the traditional fee-for-service model we have to an all payer model in which each of the hospitals is paid a fixed amount based on the population served. The fee-for-service model is what we’re trying to move away from, it’s the system that has produced costs that are not sustainable. The all payer model focuses on prevention, which means the financial incentive is realized when the population’s health improves.

It’s a hard lift. It involves changing the health care culture. Instead of a health care system that depends on sickness for its survival, we’re pushing for a system in which wellness is where the money is.

It’s fine to be a critic of the system, to figure out ways to improve what it does. But it’s not defensible to tear it down, and have nothing to put in its place, to allow the progress to fade and for us to fall back into past habits and a broken system.

That’s irresponsible. It’s also simplistic, and easy to do. OneCare is an unknown to most. It’s complicated. It sounds big and bureaucratic. It’s perceived to be part of the old boy health care network and for some reason it’s seen as a less desirable option than a single payer system, hence, it draws the ire and skepticism of the political left.

What’s odd about this is that the OneCare model should have the support of both the left and the right. For conservatives, it’s a value-based system that has already saved us millions of dollars in reduced hospital budgets. For liberals, it’s a departure from what we had to a system that builds from the bottom of the health care system — primary care — to the top, and it focuses on peoples’ well being, their day-to-day health.

That’s why OneCare’s model is being championed by the feds. It’s working.

The Green Mountain Care Board realizes the potential of OneCare as well, which is why it has pushed back against Mr. Hoffer’s allegations that OneCare hasn’t participated in community health care programs to the extent the GMCB required, but has welcomed Mr. Hoffer’s attention toward what the board considers a vital part of Vermont’s health care future.

Because there is such confusion surrounding OneCare and its mission, and because this confusion makes it vulnerable, OneCare [and the hospitals that constitute its existence] need to launch a full court press in defense of their mission. It’s too important to allow the misinformation that exists to prevail.

by Emerson Lynn

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