The Scott administration has announced that most state employees will participate in OneCare Vermont as part of an agreement with Blue Cross Blue Shield of Vermont.
Under the deal outlined Monday, BCBS, which administers health care plans for state employees, will include state workers in OneCare. Vermont officials say the move will help bolster the state’s all-payer system, which is run by OneCare.
Employees won’t see changes to their health care — they can continue to see the same doctors and receive the same care.
The deal comes after a September 2020 warning from the federal government that the state had fallen behind on participation targets for the accountable care organization.
About 19,000 out of 25,000 state employee family members are “attributed,” meaning their health care is paid for differently through OneCare. The Scott administration estimates that for calendar year 2021, the new agreement will provide OneCare 13,300 new members.
“By including the State Employee Health Plan members in the ACO, 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,” Human Services Secretary Mike Smith said in a statement Monday. The more people who participate, the higher the chances that Vermont’s attempts that lowering health care costs and improving quality will work, he said.
In September, the Centers for Medicare and Medicaid Services warned that Vermont had failed to meet its targets for two years in a row.
In response, Smith vowed to “reboot” the system, and proposed a set of sweeping changes.
Under the deal between the Scott administration and BCBS, state employees can opt out of OneCare if they prefer. Their primary care doctors must also participate in the accountable care organization.
In 2019, the Vermont State Employees’ Association balked at participating in OneCare.
At the time, Steve Howard, the executive director of the union, said members were concerned about whether a deal with the accountable care organization would water down their plans.
In an interview on Monday, Howard said the union would be meeting soon to go over the agreement and the health care plan. Howard added that it’s unclear whether the Vermont State Employees Association can bargain over the change.
“That’s still an open question,” he said.
To come to an agreement with Blue Cross, the Scott administration worked with a joint union and management panel, called the Benefits Advisory Committee, to mitigate issues related to the state employees’ health care plan.
Beth Fastiggi, commissioner of the state Department of Human Resources, said the deal with Blue Cross does not impact health care premiums or co-pays, and has no impact on existing health care plans for state employees.
OneCare administers the state’s all-payer model, which aims to change the way health care is paid for. Doctors and hospitals participating in OneCare are paid a flat fee for each patient, rather than for each procedure they perform.
That’s meant to incentivize providers to keep people healthy rather than performing more costly treatments.
However, OneCare officials say the system will only be effective when the most Vermonters participate in the system.
In 2021, about 238,000 people are expected to participate in OneCare. The state was supposed to reach a goal of about 322,000 — or 58% of the 545,000 eligible population — by the end of 2020.
