Nine of Vermont’s 14 hospitals have agreed to participate, to varying degrees, in the state’s all-payer experiment, starting next January. But some major health care providers, including the Community Health Centers of Burlington, are opting out — for now.
OneCare Vermont, the accountable care organization that is spearheading the move toward an all-payer system, announced the participants Tuesday.
OneCare estimates that 120,000 Vermonters will receive health care next year through the all-payer model, in which health care providers are paid based on patient health outcomes, rather than the number of procedures performed.
“It’s a huge step — 120,000. I’m happy with it,” OneCare CEO Todd Moore said.
That number is substantially bigger than the roughly 30,000 Medicaid-insured Vermonters who are currently part of an all-payer pilot that began earlier this year. But it’s smaller than the 137,000 that OneCare estimated it would have during its budget presentation this past June.
Moore explained that three hospitals decided to participate only with Medicaid patients — not those covered by Medicare or commercial insurance. That, coupled with the decision of Community Health Centers of Burlington, reduced the number of participants.
"Joining OneCare is a wonderful opportunity that would take a lot of work," said the centers' chief medical officer, Peter Gunther, who said they support the initiative but aren't prepared to join next year. CEO Alison Calderara noted that the centers are concerned that joining OneCare could increase the "administrative burden on the primary care providers."
"We want to be sure we are doing everything we can to support them in the clinic," Calderara said.
Only two of the state’s federally qualified health centers have opted in so far, and independent doctors aren't exactly signing up in droves. In a press release sent Tuesday, Moore touted the fact that 24 primary care practices and 30 specialty practices are participating next year.
As part of Vermont's agreement with the federal government, which authorized the all-payer initiative, the state will have to ensure that a certain percentage of eligible Vermonters are covered under the all-payer model each year. To work, OneCare needs a critical mass of primary care providers to bring their patients into the model.
Under all-payer, insurers will give OneCare a block payment to provide health care for the 120,000 individuals. OneCare will then allocate those funds to the participating providers.
The participating hospitals are:
University of Vermont Medical Center in Burlington