The two big academic medical centers serving Vermont, often seen as rivals, joined with 13 other Vermont hospitals and health clinics to form a new accountable care organization—OneCare Vermont—to focus on efficiency and quality in healthcare. The announcement by Burlington-based Fletcher Allen, a teaching hospital affiliated with the University of Vermont College of Medicine, and the Dartmouth-Hitchcock Medical Center, the hospital affiliated with Dartmouth’s Geisel Medical School, followed approval of the new ACO and 105 others by the CMS under Medicare contracts effective Jan. 1. OneCare will deliver care to 42,000 of Vermont’s roughly 118,000 Medicare beneficiaries, and officials said it was the first in the country with statewide reach. “OneCare Vermont represents a huge shift in medical practice in Vermont,” said Dr. John Brumsted, president and CEO of Fletcher Allen Health Care. Todd Moore, senior vice president for accountable care and revenue strategy at Fletcher Allen, will serve as CEO of OneCare. The announcement was welcomed by Gov. Peter Shumlin, who is working to move the state toward a universal, single-payer healthcare system by 2017. “The success of healthcare reform depends on transforming into a more effective, efficient healthcare system,” Shumlin said in a statement. “We need our healthcare providers to lead this effort.” When Brumsted and Moore presented the OneCare plans to a state Senate committee, some members expressed concern that the statewide reach would lead to a healthcare monopoly in Vermont.