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For many, the conversation around health care and health policy can seem like a foreign language with so much jargon that it is hard to translate. Let me try to be more straightforward in an effort to share information that may be of interest when we’re talking about such an important and deeply personal issue, and a large part of our state’s economy.

First, health care costs too much for too many Vermonters. Second, when we invest in prevention like annual exams and colonoscopies and in chronic disease management for high blood pressure or diabetes, we can save money and improve the quality of life for people. When providers like doctors, mental health experts, physical therapists and visiting nurses working at different places are all working together to take care of the whole person, we can save money and improve the quality of life for people.

It sounds straightforward, and it is. What’s more challenging is how to invest differently in the system in order to achieve these goals. That’s where the All-Payer Model and OneCare Vermont come in. This is precisely what we are on our way to creating here in Vermont.

VERMONT’S ALL-PAYER MODELIn 2013, Vermont signed an agreement with the federal government to develop an All-Payer Accountable Care Organization (ACO) model. The name of the model is complicated, but what matters is what the model does. The model asks doctors and hospitals in Vermont, through their work with OneCare, to sign on to change the way they practice medicine in two ways. One is to be paid in a new way: for the value they provide and the quality of care they deliver, not the volume or number of tests, procedures, and appointments they deliver. Instead of being paid for each thing they do, providers receive a set amount each month for each of their patients.

The second change is to deliver care in a more holistic way. The payment change I just mentioned empowers providers to deliver care differently. It requires providers to be accountable and to work together, supported by OneCare, to keep people healthier and reduce costs over time. Instead of tracking billable time, providers and patients can focus more on what really matters: better health. And we are making progress. In 2019, providers in OneCare made improvements in controlling blood sugar levels in patient with diabetes, achieving statistically significant results in the Vermont Medicaid and BCBSVT programs. They also increased the number of at-risk Vermonters (those who have or are likely to develop chronic diseases) in care coordination by 600 percent, and ranked third in the nation for their use of the Skilled Nursing Facility waiver which helps people access this important care without having to go through lengthy and costly hospital stays first.

WHY THIS MATTERS DURING COVID-192020 is a year that will mark time for a generation. When the pandemic hit, doctors slowed and stopped in-person health care visits to help prevent the spread of coronavirus. That means that providers being paid for volume stopped getting paid immediately. On top of massive layoffs and closed schools, the pandemic caused financial strain on almost every health care organization in Vermont, leaving some on the verge of closing their doors. The providers of OneCare, however, continued to be paid because even when in-person visits were on hold, providers received fixed, predictable payments that gave them serious stability at a time when it was desperately needed.

ONECARE BUDGETOneCare Vermont recently filed its 2021 budget with the Green Mountain Care Board, and we look forward to telling the latest chapter in this ongoing health care reform story. We are showing the value of this collaborative and cooperative effort, including that more providers chose to join more programs and we have 28,000 more Vermonters covered this year than last.

We can be proud of our progress. Providers are working together on this investment in our future. Changing the way we pay for and deliver health care takes commitment and time. We still have a way to go to help achieve our state’s vision for health care reform, but we are committed to doing our part to make changes that will benefit Vermonters.

Vicki Loner, RN, is the CEO of OneCare Vermont. She resides in Hinesburg. To learn more about OneCare’s network and initiatives, please visit For more information about OneCare, read the newly released 2019 OneCare Annual Report at


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