On December 28, 2022

Blue Cross to pause relationship with OneCare in 2023

Blue Cross and Blue Shield of Vermont (Blue Cross) will forgo a contract with OneCare Vermont (OCV) for the 2023 plan year. Despite having collaborated with OCV every year since its inception, Blue Cross is unable to reach an agreement this year due to the lack of tangible quality outcomes, inability to bend the cost curve, and the new data approach that introduces concerns about security and privacy. For nearly a decade the local non-profit health plan has led in the development of the commercial health insurance component of the Vermont all payer model (APM). As the first APM model is revised, improvements must be incorporated to better serve a diverse commercial population.

“Despite our best efforts, we were unable to arrive at an arrangement that serves our members for the next plan year,” says Andrew Garland, vice president of client relations and external affairs at Blue Cross and Blue Shield of Vermont. “This means that after Dec. 31, 2022 Blue Cross members will no longer be attributed to the All Payer Model through OneCare Vermont’s programs. Importantly, our members will not experience any difference in their plan benefits, services or support from Blue Cross.”

Blue Cross will continue to support providers, especially primary care practices, who deliver essential care to members using the principles of the APM. To this aim, the health plan will continue the per-member-per-month (PMPM) value-based payments for attributed members during this period of transition to ensure financial stability and to support practices that have worked at the forefront of health care reform efforts. Blue Cross will continue  to move away from fee-for service encounters and help the system transition to new payment models that enable better care delivery that result in tangible quality improvements. Vermonters’ limited health care resources must be directed keenly at improving health outcomes.

Blue Cross remains committed to health care reform in Vermont. The organization actively participates in state health care reform efforts and will continue to work with government partners, regulators and providers with the strict aim of improving health and wellness while reducing costs for our members, and improving the health care system for everyone.

“We support the state of Vermont’s APM construct, specifically the goals to align our entire health care system around the challenges of access, affordability, and equity,” says Garland.

Blue Cross’ participation in the state ACO program began in 2014 and progress was achieved over the original term of the CMS innovation waiver from the initial planning years through the 5-year demonstration program. Blue Cross, together with its  partners at OCV, built the data capabilities, quality measurement programs, and the financial backbone of the APM. The organizations moved from a shared-savings arrangement through to a risk-bearing model and expanded membership from the Affordable Care Act marketplace to include multiple types of health coverage.

“At every turn, we have held the principles of patient quality outcomes and affordability for our members at the center of health care delivery system reform,” says Garland. “Improvements to our health care system are sorely needed and at Blue Cross we are diligently working towards these goals. We look forward to conversations with the ACO to determine how we might be able to work together in the future.”

Blue Cross has pursued parallel reform efforts in 2022 under Vermont Blue Integrated Care. SM Working directly with providers through value-based arrangements, these partnerships test the keystone of health reform, pairing shared risk and a per-member-per-month care coordination payment with measurable patient quality outcomes. Using shared data and shared incentives that benefit both providers and members, Blue Cross is improving patient health outcomes while putting downward pressure on the cost of premiums by emphasizing high value, high impact care.

Blue Cross and Blue Shield of Vermont is the state’s only local, not-for-profit health plan. For over 30 years, the organization has been enhancing the health and well-being of the Vermonters by offering innovative plans to individuals, seniors, and businesses. Employees are dedicated to developing new ways to support high-quality care and programs and events that promote wellness.

For more info, visit bluecrossvt.org.

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