State auditor: Blueprint reports show data gaps and do not prove net savings as Bill 197 advances

Deputy State Auditor Jonathan Kingston told legislators on April 8 that recent audits of Vermont’s Blueprint program and alternative‑payment models show the programs are not being evaluated in a way that proves they produce net savings.

Kingston, who led the presentation of two audits and a separate Blueprint review, said the audits found cases in which targets and reported cost differences are misleading without additional analysis. "What we saw was data, but we don't know why the delta," he said, warning that reported per‑member cost differences should not be interpreted as proof that Blueprint caused savings.

The presentation matters because Bill 197 includes provisions related to Blueprint and primary care spending. Kingston said the audits were intended to give legislators objective information to weigh policy choices and to caution against adopting program expansions without clearer evaluation of impact and implementation costs.

The auditor outlined two findings from earlier reviews of alternative‑payment models: the Green Mountain Care Board had not developed a methodology to determine whether OneCare’s operating costs would be outweighed by benefits, and several quality‑measure baselines were already at or above stated targets, reducing the measures’ usefulness for showing improvement.

On the Blueprint audit (released February 2025), Kingston said the program "was not assessing the program's impact and was misleading about cost savings." He gave a concrete example: a yearly per‑member cost difference published in Blueprint materials, when multiplied across attributed members and years, produced an almost $3 billion figure; Kingston said Blueprint staff told auditors they were "not saying that we're saving money," and that further causal analysis is required.

Kingston also flagged a data‑coverage issue: the dataset Blueprint uses (Vcures) covers roughly two‑thirds of Vermonters, and within that dataset the attributed population was about 60% of the captured patients at the time of the audit. That means comparisons depend heavily on which denominator is used and on which providers or insurers report into the dataset.

The auditor further noted the cost comparisons relied on claims data and did not include Blueprint’s own payments for services and investments. "If you want to know whether a program is saving money, you also need to look at what it costs to implement that program," Kingston said.

Kingston cited a 2017 CMS study the auditors reviewed that reported about $64 million in Medicare savings attributed to Blueprint but also found increases in Medicaid expenditures for children (57–67 million) and adults (about 40 million), producing a combined change that exceeds the Medicare savings in that study. Kingston said selective reporting of savings without the full context can mislead legislators and the public.

Auditors also found gaps that limit interpretation: roughly 25% of Vermont primary‑care providers were not attributed to Blueprint in the dataset and auditors found no evidence explaining which practices were excluded or why. The audit did not examine Blueprint’s distribution of grants to community health teams, community‑level operations, or whether Blueprint surveys providers; Kingston said Blueprint surveys patients but not providers.

Kingston said Blueprint staff were responsive to audit recommendations, that recent reports are clearer and that Blueprint has developed a strategic plan. A follow‑up audit is under way and Kingston said auditors are working to publish it after completing accessibility checks. "The information you receive and the public receive should be clear about what it means, what it does not mean, and its limitations," he said.

Committee member Daisy (last name not provided) asked whether the audit found management weaknesses that might put Blueprint members at risk; Kingston said those operational concerns were outside the scope of the audit and were not assessed. The committee ended the session after a brief Q&A.

Lawmakers considering Bill 197 will have audit findings and a follow‑up review to inform whether and how to expand Blueprint or change primary‑care spending; Kingston recommended rigorous, causal evaluations and transparent reporting before treating observed cost deltas as proof of program savings.