This commentary is by Rob Hoffman of Quechee.
The Green Mountain Care Board is presently deliberating over the 2022 annual budget submission for Vermont’s all-payer model accountable care organization, OneCare Vermont — whose parent company is the University of Vermont Health Network.
OneCare has been tasked as the all-payer model’s partner with existential importance. For Vermont to cap cost growth without limiting access to and quality of care, the curbing of health care costs must be achieved by the purported cost-saving benefits of care coordination.
This requires investments in the case of OneCare in what are called “population health management” (PHM in the chart) investments. As a nonprofit, this would be considered the mission portion of OneCare’s declared nonprofit purpose.
Since 2020, based on OneCare’s request of the Green Mountain Care Board, these essential population health management investments have declined $3.8 million, or 11.6%, while concurrently total salaries and fringe increased $1.3 million, or 15.6%, and total administrative costs increased by $1.24 million,or 8.9%.
Against this backdrop of decreased spending on mission in favor of increased staffing spending for less work, it’s important to consider the compensation of the OneCare’s leadership. Leaders of accountable care organizations are normally paid as hospital leadership team members — which each one of OneCare’s employees is; their checks are drawn on University of Vermont Medical Center accounts.
This is an important distinction. It underscores that a business unit — in this case, OneCare — within a hospital, while having titles such as chief executive officer, are still just vice presidents of the parent organization.
During the Green Mountain Care Board annual budget process, OneCare had been asked to provide an evidence base for its compensation levels against industry benchmarks. It did not do this in a substantive way.
The below demonstrates OneCare’s total leadership compensation, national median compensation for hospital administrators, and the variation between the two.
As can be seen in the above variance column, OneCare’s leadership is commanding $1.3 million greater — or double the national median compensation for the same roles.
The important takeaways:
- OneCare’s total staff compensation increased by $1.3 million.
- OneCare’s total operating budget increased by $1.24 million.
- Therefore, all requested budget increase is staffing related for performing less mission by the amount of $3.8 million.
- Concurrently, OneCare leadership is paid twice as much as — or $1.3 million greater than — the national median compensation for the same roles
Vermonters must call upon the Green Mountain Care Board and their local legislators to demand the following:
- The Green Mountain Care Board must level-fund OneCare’s population health management/mission investments back to 2020.
- The Green Mountain Care Board must commensurately reduce total organization compensation — level-funded to 2020.
- The Green Mountain Care Board must reduce total leadership compensation to national median levels.
In an era when Vermonters are dying and committing suicide in pain, waiting months and even years for care, it is unconscionable that scarce tax and premium payer dollars are being upwardly redistributed to elites.
The Green Mountain Care Board is currently accepting public comment on the proposed OneCare budget.
I encourage Vermonters to copy and paste the above three demands and submit them as “ACO public comment” to Christina McLaughlin at christina.mclaughlin@vermont.gov and write and call their legislators, demanding greater fiscal prudence with their scarce tax and premium dollars.
