Those seeking to reform Vermont’s health care delivery system need to focus on correcting two errors in past reform efforts.
The first correction is recognizing that if an accountable care organization is controlled by a teaching hospital, it has an inherent conflict of interest in achieving the goal of lowering health care costs. Such is the case now with the relationship between OneCare Vermont and the University of Vermont Medical Center.
The second is admitting that the government entities and legislative committees responsible for overseeing and directing Vermont’s accountable care organization lack the cohesive leadership, vision and political will to do this job.
These are not new insights. Concern for mounting health care costs led the Public Oversight Commission under then-Gov. Jim Douglas to observe in 2007 that:
- The system (of authorizing annual cost increases) is self-perpetuating. Hospitals tend to add programs and services, requesting rate increases to cover revenue shortfalls and to maintain operating margins.
- Hospital strategic plans don’t adequately reflect planning for downside (risk), or alternative scenarios.
- The HRAP (the state’s health resources plan) should be updated to reflect a clear vision of what the delivery system should look like in 2020.