In 2011, Gov.
One of the principles – #13 – was the need for a “partnership between consumers, employers, health care professionals, hospitals and the state and federal government.” It was understood that success would require working together, putting aside individual interests.
Today, that “partnership” lies in tatters. On the “working together” front, we’re failing. The open question is whether
The latest blow came last week when BlueCrossBlueShield [BCBS], the state’s largest insurer, made the surprise announcement that it was pulling out of its contract with OneCare Vermont, the state’s
The insurer had not communicated with OneCare that it intended to pull out before the contract took effect, which was
The insurance company also took a gratuitous shot at OneCare saying it was also concerned about OneCare’s “lack of tangible quality outcomes” and its “inability to bend the cost curve.” The insurer was repeating the same question raised by several members of the Green Mountain Care Board who recently asked OneCare officials to defend themselves, to show the board how its multi-million budget was benefiting Vermonters.
OneCare officials opted not to respond.
To say that’s unfortunate is an understatement. There have been three recent federal audits of OneCare’s performance this year, the latest came earlier this month from NORC at the
The federal government, specifically the
But the health care profession is complicated. Health care reform is hard to explain and it’s easy for skeptics, or those opposed, to distort the information. The health care profession – writ large – is also little more than a collection of self-interested bodies.
Which partially explains BCBS’s decision to pull out of OneCare. The company prefers the status quo. The company knows how to make money under the existing system, whereas payment reform poses an existential threat. BCBS saw its opening when the GMCB raised questions about OneCare’s performance and its inability to defend itself. It made OneCare look weak. BCBS pounced.
OneCare has a story to tell. It just doesn’t tell it. It doesn’t have the means or the leadership to advocate for itself. OneCare’s weakness, paired with the effects of the pandemic, puts
The consequences of a continued decline are real. Primary care doctors could find themselves cut out of the government’s revenue stream. Health care prevention efforts could wither. We could easily find ourselves back with a system that values volume over value. We could end up right where we began in 2011.
But would the masses rise in protest? Would there be a sense of loss?
Probably not. But not because the failures were not real, but because the “plan” was never fully explained. The expected bumbs along the way were never defended. We were conditioned to think that payment reform was something that could be done, and done with dispatch.
There are a number of reasons why we are where we are, but the overriding reason is a lack of leadership.
This lack of leadership has allowed the various parties to make their own rules with little fear of being challenged. That lack of leadership is what puts the current reform efforts deeply at risk.
To Vermonters, that is unacceptable. And, frankly, an outrage. Health care represents 20 percent of the state’s economy. All 630,000 of us depend on the system for our health. And we all pay dearly for that benefit.
Why do we allow something of such importance to be ignored by those who lead us and those in charge of the various parts of the system?
We shouldn’t. Gov.
There is no Plan B. It’s time to act accordingly.
Here's what the outgoing CEO of Blue Cross says about the future of health care
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Health care reform up in flames. Anyone care? – Insurance News Net
In 2011, Gov.