Vermont All-Payer ACO
Vermont All-Payer Accountable Care Organization (ACO) Model
The Vermont All-Payer ACO Model is a CMS test of an alternative payment model across Medicare, Medicaid, and commercial payers in Vermont. It incentivizes health care value and quality, focusing on health outcomes under the same payment structure for the majority of providers throughout the state. The model aims to redesign the entire care delivery system and transform health care for the entire state population.
Innovation
It aligns ACO design (quality measures, risk arrangement, payment mechanisms, and beneficiary alignment) across all significant payers (Medicare, Medicaid, and commercial) in a state, establishing state and ACO-level accountability for health outcomes for the entire population.
The Problem
In a traditional fee-for-service health care system, hospitals, physicians and other medical service providers are paid based on the number of patients they treat, and health care services provided, without regard for the quality of care provided or the outcomes achieved.
The Solution
The model brings together physicians, hospitals, and other health care providers to better coordinate care for patients with Medicare, Medicaid, or commercial insurance. It ties payment to the quality of care given rather than the number of tests, procedures, or office visits.
Expected Outcomes
Patients are more likely to receive treatments that meet their specific needs and less likely to get unnecessary, repeat medical tests. Doctors are better positioned to identify potential problems sooner, including chronic conditions, mental health issues, and substance misuse, and begin early intervention to improve overall health.
Strategy
The model contributes to the Administration's goals of having 50 percent of all Medicare fee-for-service payments made via alternative payment models by 2018, and accelerates delivery system reform by partnering with states to implement payment and care delivery reform across all major payers.
Model Goals
- Drive meaningful improvements in the health of the state's entire population by transforming relationships between care delivery and public health systems.
- Encourage Vermont payers and providers to participate in ACO programs such that by 2022, 70 percent of all Vermont insured residents are attributed to an ACO.
- Limit the annualized per capita health care expenditure growth for all major payers to 3.5 percent.
- Limit Medicare per capita health care expenditure growth for Vermont Medicare beneficiaries to at least 0.1-0.2 percentage points below projected national Medicare growth.
- Achieve Health Outcomes and Quality of Care targets in substance use disorder, suicides, chronic conditions, and access to care.
Patient Eligibility
Vermont residents who are attributed to an ACO and have Medicare, Medicaid, or commercial insurance.
- Must be a Vermont resident
- Must have Medicare, Medicaid, or commercial insurance
- Attributed to a participating ACO
Provider Eligibility
Physicians, hospitals, and other clinicians in Vermont participating in an eligible ACO.
- Must be located in Vermont
- Must participate in an eligible ACO
- May not simultaneously participate in the Medicare Shared Savings Program (for the Medicare ACO Initiative)
Care Categories
Behavioral Health
Chronic Disease Management
Primary Care and Access
CMS Benchmarks & Thresholds
financial
operational
population
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