MONTPELIER — The State of Vermont has finalized an agreement with Blue Cross and Blue Shield of Vermont to add about 13,300 employees covered under the state health plan to the state’s all-payer model program OneCare Vermont.
Blue Cross Blue Shield of Vermont administers the state’s self-insured employee health plans and has a contract with OneCare Vermont allowing Blue Cross Blue Shield to add members to the all-payer model.
The addition of state employees is among steps being taken by the state Agency of Human Services to boost participation in OneCare Vermont, as the state strives to meet patient participation requirements. In September, the federal Centers for Medicare and Medicaid Services, the agency working with Vermont on the pilot project, warned the state had failed to patient participation targets in 2018 and 2019.
Federal regulators had set a target of 70 percent participation by the time the six-year program expires in 2022. As of November, participation sat at 42 percent, according to a state report on the system.
“Healthcare reform is still taking shape in Vermont, but we’re moving in the right direction towards our goals to prioritize prevention, improve patient outcomes and make health care more affordable in future years,” Mike Smith, Secretary of the Agency of Human Services, said in a news release announcing the move. “By including the state employee health plan members ... it will not only help the program to better meet the participation goals of the all-payer model but will provide more experience to judge the efficacy of this approach.”
The all-payer agreement is a contract between Vermont and the federal Centers for Medicare and Medicaid Services. It’s intended to reward OneCare Vermont and its member providers for efficiently delivering high-quality services and maintaining patients’ health and wellness. OneCare then provides its members predictable prospective payments — rather than fee for service reimbursements — in return for providers working efficiently within a budget to provide high-quality care.
The Scott administration said it “thoroughly examined” the plan to ensure the change will not impact employee benefits, premiums, copays, or the financial health of the plans. The administration also said it worked with the Benefits Advisory Committee, a joint union and management committee created to advise the administration on state health care plan issues, and crafted an agreement with Blue Cross Blue Shield of Vermont including the committee’s input.
State employees will have the option to “opt out” of sharing their information with OneCare Vermont.
“This is a positive step forward for the Administration’s payment reform efforts, which are moving us to a system that pays for quality care over quantity of care to keep Vermonters healthier while slowing growth of healthcare costs in the long term,” Secretary of Administration Susanne Young said in the release. “This work provided a great degree of transparency, as well, to the Benefits Advisory Committee so it understood the impacts of the Administration’s decision.”
In November, Smith said he was “committed to making all-payer work,” adding that moving away from fee-for-service reimbursement proved its worth when it brought financial stability to the healthcare system during the early days of the COVID-19 pandemic.