Vermont health care regulators approve OneCare’s annual budget, likely its last – VTDigger

For likely the last time, state health care regulators at the Green Mountain Care Board on Wednesday approved the annual budget for OneCare Vermont, the accountable care organization that has been the linchpin of Vermont’s “all-payer” health care payment reform efforts since 2018.

OneCare announced in early November that 2025 would be its last year in operation. Dec. 31, 2025, is also the anticipated end date for what the Centers for Medicare and Medicaid Services calls the “Vermont All-Payer ACO Model.”

The care board approved an organizational budget of just under $11.3 million, a reduction of almost $1.5 million from OneCare’s original request, submitted before the nonprofit’s board of managers voted to close its doors. 

Regulators directed OneCare — which since October 2021 has been solely a subsidiary of the University of Vermont Health Network — to redistribute the latter amount to independent health care providers that participate in the organization’s “population health management” programs, including primary care offices, home health agencies and area agencies on aging. 

Green Mountain Care Board Chair Owen Foster called the approved budget “very fair for OneCare,” given that it was not significantly lower than the organization’s actual spending in 2024.

The reduced budget level-funded salary and benefit expenses from 2024 and eliminated the unfilled position of chief financial officer. Tom Borys, who served in that role, took over as interim chief executive officer after Abe Berman, who served as OneCare’s CEO since May 2023, stepped down earlier this month. 

The care board also cut money that was allocated to pay for an annual outside evaluation no longer being required by the board, and for lobbying and board recruitment. 

“It’s obviously a different budget than in prior years with a winddown coming of the operations,” Foster said. 

Borys acknowledged that “the paradigm has changed for us” and accepted the rationale for the cuts in public comments to the board on Dec. 4 and written comments on Dec. 12. The organization’s goal for 2025 was to “do our best for the state, the providers, the patients that they serve, and also be mindful of the cost,” he said. 

Borys added that OneCare expected to continue its full list of activities through the end of 2025. The plan is to spend the first half of 2026 closing down, with the final steps of the shutdown completed by that October, he said. Care board staff said it was currently unclear whether the regulator would need to approve a partial budget for 2026, assuming the federal “all-payer model” ends when expected at the end of 2025.

The model has been a unique policy framework — and the basis for a legal contract between the federal health insurance agency, Vermont’s Agency of Human Services and the care board — that has allowed Medicare and Medicaid funds to be distributed by an accountable care organization in nontraditional ways. 

The new payment methods have included adding bonus payments for providers who meet certain care quality standards and “per patient per month” payments to independent primary care providers. The strategies were intended to bolster preventative care and reduce overall health care spending. 

For the duration of the model’s contract, which started in 2018, OneCare has been Vermont’s only “all-payer” accountable care organization — meaning it does business with private providers, Medicaid and Medicare — so it has been the only entity capable of carrying out the terms of the agreement. 

In late November, the care board approved the 2025 budgets of Lore Health, Vytalize Health and Aledade Accountable Care as submitted. All three are accountable care organizations operating in Vermont that provide services only to patients insured by Medicare. 

On Wednesday, members of the care board also received an update on negotiations with the Centers for Medicare and Medicaid Services over Vermont’s participation in a new federal reform model called the AHEAD program, which stands for States Advancing All-Payer Health Equity Approaches and Development. 

Vermont is one of six states that has been selected to participate. The others are Maryland, Connecticut, Hawaii, New York and Rhode Island.  A care board vote on whether to move forward with preparations to participate is expected in mid-January. 

Care board member Thom Walsh questioned whether President-elect Donald Trump’s incoming administration would back the federal reform program’s continued rollout. If it did not, he asked, did leaders at the Agency of Human Services have a backup plan for funding programs that health care providers and their patients have come to rely on?

OneCare did successfully defend one part of its 2025 budget: the continuation of its “regional care representative” program, which the care board had put on the chopping block. 

The $300,000 pays primary care providers within OneCare’s network to work with peers in their region on how best to make use of the data and reports the ACO provides. The program is needed for the organization to maintain a connection with those offices, which is essential for progress towards shared care quality goals, Borys said. 

“I’d like personally to end the all-payer model era on a high note,” he said.