Questions and Answers about the OneCare Accountable Care Organization (ACO)

What is an Accountable Care Organization (ACO)?

An ACO is a group of doctors, hospitals, and other health care providers who work together to provide coordinated high-quality health care to their patients. An ACO supports health care providers by making sure they have the most up-to-date information about their patients’ health and care. As an ACO, OneCare joins providers and communities together to improve the health of Vermonters. OneCare gives health care providers access to resources to help coordinate their patients’ care and services within communities. By sharing information and working together, providers can do more to help patients get the best possible coordinated care.

Will participation in OneCare change our benefits?

No. Our benefits are negotiated solely between the State and VSEA, in accordance with Vermont statute. All the benefits, copays, terms, and conditions of the State Employees’ Health Plan will remain exactly as they are now.

Can OneCare ration health care under our plan?

No, see above.

Can I still see my Vermont doctors and specialists?

Yes.  OneCare does not impact which providers you can see.  You can still see any doctor, hospital, or specialist who is covered under the State Employees Health Plan, just as you have in the past.

What happens if I get my health care out of state?

OneCare does not include out of state providers.

Will participation in OneCare increase our premium rates?

The participation cost is too small to increase our health plan premium rates.  In addition, our plan carries a healthy surplus to cover unexpected claims.

Is our prescription drug program involved with OneCare?

Our Express Scripts prescription drug program is NOT included in OneCare participation. 

Can I “opt out” of OneCare? 

Participation in OneCare happens through your provider(s).  If you are seeing a provider who is participating in OneCare, you are considered participating in OneCare.  Your provider will be sharing their patients’ aggregated health care data, with OneCare but not individual data.  However, if you wish, you may “opt-out” of having your data shared in the aggregated data that will go to OneCare. You will receive a letter and form from OneCare early next year providing that opportunity.

Why is the State Employees’Health Care Plan required to participate in OneCare?

The State’s current Administrative Services (ASO) contract with BCBSVT allows BCBSVT to contract with “provider networks” (groups of doctors and hospitals) on behalf of the State Employees’ Health Plan. This has been a longstanding practice. The State and BCBSVT believe that OneCare is a “provider network” under the terms of the State’s current ASO contract with BCBSVT. Therefore, both the State and BCBSVT believe that BCBSVT has the right to require our health plan to participate in OneCare – and the State has agreed to do so as of January 1, 2021. VSEA is not a party to the State’s ASO contract with BCBSVT. VSEA has the right to consult with the State, make inquiries, and to verify that the decision-making process involving OneCare is consistent with the terms of our health plan and our collective bargaining agreement. We have done all this and we are continuing to stay involved through the Benefits Advisory Committee and to demand accountability and transparency from OneCare and BCBSVT.

Will the State contract directly with OneCare?

No. OneCare contracts with health plans through insurers like Blue Cross.  The State must amend its current ASO contract with BCBSVT to include participation in OneCare.  The VSEA Benefits Advisory Committee has worked very closely with the State and BCBSVT – to ensure that the ASO contract amendment protects our health plan and our members.  VSEA has added language requiring, “no diminution of benefits”.  This means that OneCare cannot change or reduce benefits or restrict who you see as a provider under our plan.

Why does the State Employees Health Plan have to participate in OneCare when the Teachers’ health plans do not?

This goes back to the State’s ASO contract with BCBSVT.   The State’s ASO contract with BCBSVT allows BCBSVT to align our plan with OneCare, as a “provider network”.  The Teachers’ health plans are set up differently.  The decision to participate in OneCare does not rest with the union (Vermont-NEA) or with the local school boards, but with the Vermont Education Health Initiative (VEHI).  VEHI is an inter-municipal risk pool that provides health plans to school employees and retirees through their school districts and the retirement system.  VEHI’s Board decided not to participate in OneCare in 2020.

Is there a cost to our plan to participate in OneCare?

In 2021 there will be $3.25 per member per month fee which will not change up or down.  In future years the fee may be adjusted up or down by BCBSVT.  Before that can happen, the ASO contract amendment will require BCBSVT to meet with the State (and by extension the BAC) each September – to discuss and justify the fee for the following year.  The ASO contract amendment will also allow the State to terminate its participation in OneCare at any time, by giving BCBSVT 60 days’ notice.  The fee is too small to increase our premium rates.

How are we going to monitor OneCare’s performance?

The BAC plans to invite OneCare to meet as early as possible in 2021 to answer members’ questions.  The BAC expects to continue these conversations with OneCare throughout the year and will keep members advised.  In addition, the State’s contract amendment with BCBSVT requires BCBSVT to monitor OneCare’s performance under our plan and report back to the State.

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