Updated at 5:53 p.m. on November 24, 2020.

Vermont is moving state employees’ health plans to OneCare Vermont amid a planned reboot of its all-payer system aimed at increasing participation among patients and providers.

Effective January 1, the shift affects about 9,000 members of the Vermont State Employees' Association and Vermont Troopers’ Association, according to state Human Resources Commissioner Beth Fastiggi. About 6,000 retired state workers are already enrolled in the system through a Medicare plan, she said.

“The more participants in the plan, the more effective it can be in helping the effort to stop the increasing costs of health care,” Fastiggi said.

OneCare is Vermont’s only accountable care organization and manages the state’s all-payer health care system. Through a federal-state partnership, OneCare collects money from Medicare, Medicaid and private insurers to pay health care providers for each patient they treat instead of for each test, visit and procedure, which experts say drives up the cost of care.

Ditching the traditional fee-for-service system has taken longer than expected. Since OneCare launched in 2017, the state has fallen short of federal benchmarks called "scale targets" that dictate how many Vermonters should participate each year. The goal is for 70 percent of residents to be included by 2022.

By the end of this year, the target is 58 percent of Vermonters, but it’s likely that only 42 percent will be enrolled, according to Ena Backus, the state’s director of health care reform.

In September, the federal Centers for Medicare & Medicaid Services issued the state a warning letter for falling short of expectations. Including state employees in OneCare is an attempt to address those concerns, Backus said.

The shift will not change employees’ benefits, including premiums or co-pays, according to Fastiggi.

“Most employees really may not notice any difference whatsoever,” she said, noting that doctors may end up calling their patients more regularly to check in. “The goal is for [patients] to receive better quality care … and that’s why I completely support this move.”


Vermont is currently in year three of a five-year experiment with all-payer and OneCare. Its under-performance has caused some groups, including the Vermont Workers Center and Vermont Health Care for All, to call on Gov. Phil Scott to dump OneCare in favor of a universal, single-payer health care system.

But state officials say they want to reboot the model, not can it.

The state released a report Thursday that outlines several steps to get the program on track — including working with the feds to determine if the benchmarks “are indeed achievable,” Backus said. The report includes recommendations for every player in the all-payer game: the Agency of Human Services, Green Mountain Care Board and OneCare itself.

“We need to take some ownership of this and lead on this to make it work,” said Scott spokesperson Ethan Latour, adding, “The amount of value the accountable care organization is adding to the reform efforts is mixed, depending on who you ask.”

Backus said the state wants OneCare to step up its recruitment to attract more providers to the model. It also needs to support providers who have already signed on, she said.

The state in particular has heard complaints about Care Navigator, an online platform that allows doctors to share patient information and coordinate care — one of the hallmarks of an all-payer system, Backus said. But only some types of providers can access the platform; others have reported that it’s not useful, she said.

“We think that the care coordination platform is extremely important … so how can we improve it?” Backus asked. “That’s the spirit of this assessment.”