OneCare is the accountable care organization whose purpose it is to shift Vermont’s health care spending from a fee-for-service model to one in which hospitals are paid on a per capita basis. It is a “population health management” system that has been in place since 2015 and, like the hospitals it services, OneCare is regulated by the five-member Green Mountain Care Board. Last week the regulators made a point of asking OneCare’s leadership if it could justify its $15 million budget request.

It could not. Not satisfactorily.

Owen Foster, GMCB’s newly installed chairman, was quoted as saying: “Vermonters, either through taxpayer-funded health care groups, out-of-pocket expenses, copays or insurance, have borne the bulk of those staggering numbers [the cost of health care generally]. And for that they deserve results.”

Or at least evidence that the organization was on the right path, which, according to the last government report, it was.

Board members asked OneCare’s directors to give examples of how the organization has saved the health care system money and to justify the continuation of its mission. Board member Tom Walsh added: “What I’m struggling to find is an outcome that would be meaningful to Vermonters, and you may be able to say something like, ‘reduced [emergency department] visits.’ Those are outcome measures that matter to patients, and I can’t find them.”

The information requested is available, but OneCare’s leadership opted not to share it.

OneCare is a small part of the state’s health care system, but the entire structure is under attack, and for defensible reasons. Health care costs have risen to unsustainable levels and it’s a burden borne by Vermonters. It’s oppressive. People want answers. They want to know better times are before them.

Last week’s hearing before the regulators was OneCare’s opportunity to provide that hope. Or at least a sliver of it. It did not.

It’s a tough environment for regulators and health care providers, including OneCare. Neither have a way forward that would cut costs and maintain quality in the near term. Regulators have the power to approve or disapprove a budget, but they don’t have the power to force providers to change course, or to guide the health care system in one direction or another. Forcing a hospital to cut its budget is not the same thing as forcing a hospital to change its delivery system, or to reprioritize its objectives.

The weakness of the regulatory board becomes the weakness of the health care system. In OneCare’s circumstance, that weakness could be its demise. It’s not difficult to imagine OneCare being forced to close its doors with hospitals shrugging their shoulders, returning to business as normal.

All because OneCare’s mission is not understood, let alone defended? OneCare has to be able to defend what it does – shifting to population health and per capita funding – convincing regulators that the end goal is the only means by which costs can be cut and quality of health maintained. It’s a worthy goal and it’s one that is working its way through the system in a variety of different ways, but you’d never know it if it were left up to OneCare to tell the story.

The peril in that failure is that it weakens the entirety of Vermont’s health care system.

Emerson Lynn