There can be no debate: Accessing health care services can be difficult at times, navigating our complex system can be confusing, and we all know health care costs too much for far too many families.
This is why the University of Vermont Health Network is “all-in” on the state’s policy demanding real changes in the way we deliver health care and the way we operate the health-care system. To achieve these incredibly difficult goals, we became a founding member of OneCare Vermont.
OneCare Vermont is a cooperative effort of providers who have pooled their resources and expertise to keep people healthy and well with a focus on increasing access to primary care, reducing deaths from suicide and drug overdose, and supporting Vermonters with chronic illnesses. OneCare is the health-care-provider community’s contribution to bringing about the change the federal government and the State of Vermont have envisioned in the All-Payer Model and, I am excited to share, we are starting to see a big difference.
OneCare brings providers and health-care organizations together with their resources, people, systems and dollars, and collectively make the investments necessary to improve the health of the population we serve. For example, we made the decision to flow more of our current funding to primary care to keep people with complex conditions from needing to be hospitalized.
We have also created flexibility for patients to receive home-health visits after a hospitalization, even if their insurance company does not believe this is necessary. This home-health strategy, by the way, has been shown to reduce the need for readmission to the hospital and the per-person cost. We have invested together in the information-technology systems and expertise that allow us to change the way we get paid for services.
These are real examples of how OneCare functions as an integral part of our health-care delivery system, avoiding the need for each hospital or provider group to go it alone with much more expensive approaches.
Like everything we do, we should be looking to carefully examine this work to see if we are accomplishing what we set out to do. Luckily, since Vermont’s effort to transform to a value-based health-care payment system is new, there are a lot of plans in place to independently evaluate how it is working.
So, what are the researchers and evaluators saying about how this is going so far? The Milbank Memorial Fund, a national foundation working to improve the health of populations and founded over 100 years ago, came to this conclusion in April of this year: “Medicaid ACOs were associated with some improvements in use, quality, and expenditures, including statistically significant reductions in emergency department visits. Only Vermont’s ACO demonstrated slower growth in total Medicaid expenditures.” Emphasis added by me.
There are other studies, including one by the Centers for Medicare and Medicaid Services, coming to similar conclusions.
I recognize we have a lot more work to do, to drive the change we need to make, and to achieve what has never been achieved before: Improved quality and patient experience, all while making care more affordable. This can only happen if all of us — the provider community, insurers (whether they be private or government), policymakers, employers and, ultimately, patients — work toward a system where everyone sees the incentive for being well versus sick.
John R. Brumsted, MD, is the president and CEO of The University of Vermont Health Network and is the current chair of the OneCare Vermont Board of Managers.