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OneCare leaders urge caution on ACO risk, urge simple goals and preserved data as Vermont reshapes payment models
Summary
Tom Boris of OneCare Vermont told a Senate committee that ACOs can relieve administrative burden and drive focused quality gains, but warned against imposing large financial risk on small practices or hospitals and urged clear goals, simpler programs and preservation of OneCare's data infrastructure.
Tom Boris, chief executive officer and chief financial officer of OneCare Vermont, testified to the Senate Health Committee on March 26 about lessons learned from operating an all‑payer ACO infrastructure and why the state should be deliberate when designing future payment and support programs.
Boris said OneCare functioned as a shared administrative entity that centralized contracting, compliance and data management for participating providers and that this decanting of administrative work can protect small rural practices from overload. He argued that the capability to aggregate data, negotiate contracts and oversee governance was valuable but resource‑intensive, and that OneCare’s statewide scale both enabled population‑level initiatives and made local tailoring harder.
Why it matters: as Vermont considers policies to strengthen primary care, Boris recommended matching the policy tool to the problem. Large, statewide goals may need broad centralized structures, he said, while community‑specific gaps are better addressed with targeted, simpler initiatives. He encouraged limiting the number of quality measures to a small set of priorities and sustaining focus over time to generate measurable improvements.
On finance and risk, Boris advised caution. He said shared‑savings contracts and arrangements that transfer large downside risk to providers should be calibrated to the balance‑sheet strength of participants. "Be cautious about big risk levels right now when it comes to any programs," he told the committee, adding that the potential for shared losses can be damaging to small hospitals and rural practices.
Boris highlighted examples OneCare ran with measurable results — a push to increase mental‑health screening in primary care that produced a roughly 10% increase in screening rates across participating practices in a year — and said simpler, focused program designs yielded faster, more reliable progress.
He urged the state to preserve ACO data capabilities as OneCare winds down contracts and to be explicit about what problem each proposed policy is intended to solve so lawmakers can judge whether an ACO‑style tool is appropriate.
Representative quote: "As future initiatives are explored, the real lesson learned here is to be thoughtful about the administrative load that falls through to practices," Boris said.
Speakers quoted for this article: Tom Boris (CEO & CFO, OneCare Vermont).
