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Green Mountain Care Board says all-payer model results mixed; trims OneCare administrative budgets and caps executive pay
Summary
GMCB testimony said the all-payer model's savings have primarily accrued to Medicare, prompting the board to reduce OneCare administrative budgets and cap executive pay; the board said it reallocated savings to population health and primary care.
Chair Foster, chair of the Green Mountain Care Board, told the House Health Care Committee on Feb. 6 that the board's review of the all-payer model shows mixed results "—I think the jury's out on that with the all payer model." He said where savings existed, they tended to benefit Medicare rather than commercial payers.
The board has acted on the OneCare budget in response, Foster said. "We did reduce the expenses" and in 2024 lowered OneCare's administrative budget by about $1,000,000 and reallocated those funds to population-health and primary-care programs. He said a further reduction of about $1,500,000 occurred in 2025 and that the board directed the reallocated money toward primary care and mental-health providers rather than administrative overhead.
Foster also described actions on executive compensation. He said the board sought transparency into OneCare executive pay, issued a subpoena that was litigated, and that the Vermont Supreme Court upheld the board's authority to require salary transparency and to impose a cap tied to national medians; the board required excess funds to be reinvested in health care.
Why it matters: The all-payer model and OneCare are central to Vermont's strategy to control costs and shift care out of hospitals; the board said alignment of hospital governance, executive incentives and state reform goals is critical to achieving cost control and better access.
Details and context: Foster said the board expects reforms to succeed only if "the hospital board is aligned to do what the state's goal is with the reform" and if hospital leadership and executives are paid and incentivized to accomplish expense control and to move care to more affordable sites.
Questions from committee members touched on future ownership and governance of the AHEAD model and whether the model would be owned by UVM or by OneCare; Foster did not provide a definitive ownership answer in the recorded portion and indicated further follow-up may be needed.
Ending note: Foster said the board will continue oversight and reallocation where administrative spending did not show sufficient return on investment, and reiterated that statutory and procedural authority supported the board's actions on budgets and executive salaries.
