Vermont’s largest insurance company will not renew its contract with the nonprofit OneCare Vermont. They promise lower health care costs and improved patient outcomes by moving away from a fee-for-service payment model for providers.
BlueCross BlueShield of Vermont announced Tuesday morning it would “pause" its relationship with OneCare, days before a new contract was set to go into effect.
"We've been negotiating with them in good faith and had a contract that both parties agreed on for the last nine months," said OneCare CEO Vicki Loner. "This was a bit of a bomb."
BlueCross told Vermont Public they've been in frequent communication with OneCare, and disagree with that characterization.
The move creates instability for many of the state's independent primary care practices, who rely on predictable payments from OneCare, according to state officials.
“Instead of getting paid a fee for service, they get paid a lump-sum fee every month,” Loner explained.
On top of that, OneCare provides over a million dollars to primary care providers across the state through the hospitals it works with.
That's one reason Gov. Phil Scott wants BlueCross to reconsider its decision.
“We’re going to be encouraging them to get back to the table,” he said at a press conference this week.
OneCare is the state’s only accountable care organization. They work with health care providers to manage theoverall health of a population. The idea is to incentivize providers to keep their patients healthy, rather than basing health care payments on the number of services provided.
“We're still fully committed to health care reform,” said Sara Teachout, with BlueCross.
But the insurance company said it couldn’t justify the money and time it takes to work with OneCare, which has faced questions about its effectiveness while operating on a $15 million budget.
“Everyone's concerned about the costs and where the premiums are going,” Teachout said. “It's been, for quite a while, difficult to see and to prove the results are benefiting our members and worth that investment.”
BlueCross has said it will continue monthly value-based payments to primary care providers until they can “transition them into a different value-based program,” according to Teachout.
But Loner, and state officials, have argued that won’t account for all the funding mechanisms OneCare provides.
“We have to think about as a board how we continue to support primary care," Loner said. "Those are the things that aren't worked out because we're just hearing about this."
Vermont Public's Peter Hirschfeld contributed reporting to this story.
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