"From the outset, [Vermont Gov. Peter Shumlin's] team embraced an Accountable Care Organization payment strategy that would enroll most Vermonters in large hospital-based, HMO-like organizations that would be overseen by a 'designated entity' -- presumably Blue Cross. To-date, ACOs have shown little or no overall cost savings, have increased administrative costs, and have driven hospitals to merge and gobble up physician practices.... The plan never envisioned including all Vermonters in a single plan, instead retaining multiple payers."

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