Preliminary results show that OneCare Vermont spent $12.4 million more than expected on Medicaid patients last year.
Those numbers, which extend through September 2019, have yet to be finalized. But if they remain constant, it marks the first time that OneCare would need the state to pick up part of the tab.
Jenney Samuelson, deputy commissioner of the Department of Vermont Health Access, said the shortfall is the result of more people than expected in the Medicaid program seeking medical care.
Still, the additional expense could prove to be a challenge for OneCare as it works to convince lawmakers and regulators that it has been effective at lowering health care costs.
OneCare Vermont, a statewide accountable care organization, collects money from Medicaid, Medicare and private insurance companies. It then pays doctors a set fee for each patient, as part of a shift away from paying for each procedure they perform. That payment is meant to lower costs by incentivizing early preventive treatment before more costly procedures become necessary.
Each year, OneCare sets an expected budget for each population — Medicaid, Medicare, and private insurance. OneCare budgeted $154 million for the 86,000 Vermonters who receive Medicaid benefits and participate in OneCare.
Over the period, from Jan. 1 to Sept. 30, spending went over budget by $12.4 million, or about 8%. The figures were published in an internal document from the Department of Vermont Health Access.
OneCare and the hospitals will cover most of the expected $8.4 million shortfall. The state would pay for the remaining $4 million, according to Samuelson.
OneCare representatives and members of the Department of Vermont Health Access both declined to analyze the results until the numbers are finalized for the full year.
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The figures exclude numbers from the last three months of 2019, as well as some of the figures that are still being processed by insurers into the new year, according to Samuelson. OneCare will present the final figures this fall.
The total “could go up, it could equally go down,” said Sara Barry, chief operating officer of OneCare.
Samuelson also downplayed the significance of the shortfall. “It is too early to tell what the results will be for 2019,” she said.
According to the state’s own document, expenditures for 2019 will likely increase as the remaining insurance claims are processed.
Whatever the additional expense, it’s less than what taxpayers would pay if the state wasn’t working with OneCare, Samuelson said.
Prior to the agreement with OneCare, if Medicaid costs were $12 million more than expected, the state and federal government would cover the entire amount, she said. Now OneCare and hospitals are on the hook for part of the cost.
The report comes at a time when OneCare seeks to expand and promote successes. Gov. Phil Scott praised the company’s progress in his budget address. It’s also only going to grow its Medicaid program: OneCare also aims to add an additional 28,000 Medicaid members to the program in 2020.
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