The Vermont teachers union won’t join OneCare Vermont this year, citing basic questions about how participating in the state’s accountable care organization will affect members’ health insurance.
The board in charge of administering health insurance for the Vermont National Education Association voted last month to postpone its decision about joining OneCare, which has been charged with implementing Vermont’s health care reform efforts.
“We want to spend more time examining and learning about OneCare Vermont’s structure, costs and quality metrics,” board chairman Joel Cook and vice chairwoman Tracy Wrend said in a joint email. They also wanted to understand its relationship with the insurance company Blue Cross Blue Shield of Vermont, they said.
The decision deals a blow to OneCare Vermont, which needs the 19,000 eligible NEA members to come close to hitting its scale goals for the year; it’s already below its targets. But for teachers, the decision doesn’t make much of a difference, said union spokesperson Darren Allen.
“Our members have heard the word (OneCare), but it’s kind of meaningless to them,” he said, adding that OneCare is “arcane” and has “no direct, discernible effect on teachers.”
In one sense, that’s true, said OneCare Vermont CEO Vicki Loner.
“The first thing that people want to understand is, ‘Are you going to reduce my benefit? Are you going to raise my co-pays? Are you going to limit the providers we can see?’ ” Loner said. “The answer is no.”
For OneCare, it’s part of a statewide push to change the way health care is funded. The accountable care organization wants to start coordinating the state’s health care and paying doctors a monthly fixed payment rather than for each procedure they perform. It’s part of an effort to lower costs and keep people healthier.
To make that shift, OneCare needs as many people as possible to participate, Loner said; the benefits, such as starting community health programs and placing mental health clinicians in doctors’ offices, come with system-wide involvement.
“One of the keys to sustaining this model is to have the whole population in so you can have shared resources,” she said.
OneCare has a goal of including 70% of eligible Vermonters by 2022. It’s currently at about 30%.
Teachers aren’t the only ones with qualms. Members of the Vermont State Employees’ Association have also expressed reservations about joining OneCare, though they have yet to make a final decision.
“We’re still holding (OneCare’s) feet to the fire, still gathering information,” said Steve Howard, executive director of the employees union. Among members, “there’s healthy skepticism.”
Like the teachers, state employees have concerns about the impacts on costs and quality of care, Howard said.
Loner said she welcomed questions and conversation from the group.
But OneCare’s messaging has been a point of concern among state officials.
“The ACO hasn’t done a great job explaining how they’re improving people’s health and reducing costs,” Gov. Phil Scott acknowledged in his budget address. Chairman of the Green Mountain Care Board Kevin Mullin told OneCare to do a better job telling its story.
The biggest challenge for OneCare has been adding Vermonters who buy private insurance from Blue Cross Blue Shield or MVP Health Care. Some larger employers have been hesitant to join; others simply see doctors that aren’t participating.
The reservations from union members are about OneCare’s approach, not so much about cost. “We think it’s less about the financial arrangement that we’re offering and more their concerns about whether the all-payer model will work and those bigger picture concerns,” said Sara Teachout, spokesperson for Blue Cross.
The two unions make up the two largest insured groups in the states. About 44,000 NEA members, family members and staff have insurance through the union, and the VSEA insures about 25,000 people. About 40% of those members see doctors that participate in OneCare; both doctors and patients must agree to be part of the accountable care organization to participate.