In conjunction with the state of Vermont, CMS announced the Vermont All-Payer Accountable Care Organization (ACO) Model on Wednesday. The new model is the first of its kind and represents an advancement in the goal of redesigning the healthcare delivery system with an emphasis on high-value care and improved health outcomes.
In conjunction with the state of Vermont, CMS announced the Vermont All-Payer Accountable Care Organization (ACO) Model on Wednesday. The new model is the first of its kind and represents an advancement in the goal of redesigning the healthcare delivery system with an emphasis on high-value care and improved health outcomes.
A key mission of the All-Payer ACO Model is to increase participation in ACO programs, with the goal that 70% of all insured Vermont residents will be included in an ACO by 2022. Participation by payers and providers is voluntary, but CMS and Vermont will encourage all to join the Medicare and Medicaid ACO Initiatives tailored to the state. In 2017, CMS will designate $9.5 million as “start-up funding” to support Vermont providers as they improve care coordination, build connections with community-based care providers, and enact practice transformation efforts.
“This model is historic in terms of its scope, aiming to include almost all providers and people throughout the state in an all-payer ACO model to drive improved quality, better care coordination, healthier people, and smarter spending,” Patrick Conway, MD, CMS principal deputy administrator and chief medical officer, said in a press release.
The Vermont Medicare ACO Initiative qualifies as an Advanced Alternative Payment Model (APM) under the CMS Quality Payment Program (QPP). As early as 2018, participating providers could be eligible to receive the Advanced APM bonus payments. According to a QPP fact sheet, Advanced APMs are encouraged because they incentivize high-quality care by having providers take on financial risk based on patient outcomes.
Vermont Governor Peter Shumlin announced in a press release that “by shifting the focus away from the current fee-for-service system to one that rewards primary care and prevention,” the agreement made Vermont the first state “to fundamentally transform our entire healthcare system so it is geared towards keeping people healthy, not making money.”
The All-Payer ACO Model also incentivizes collaboration between delivery and public health systems. Vermont has identified 4 areas they see as priorities in achieving Healthcare Outcomes and Quality of Care targets: substance use disorder, suicide, chronic conditions to care. The achievement of these targets will be the basis of the Population-level Health Outcomes measure category, which joins Healthcare Delivery System Measures and Process Milestones as the categories of metrics by which Vermont’s success will be evaluated.
The terms of the All-Payer ACO Model were approved by the Green Mountain Care Board (GMCB), the independent organization that since 2011 has been responsible for developing and implementing healthcare payment and delivery system reforms in the state of Vermont. In Wednesday’s announcement, CMS said that GMCB would be “a key partner in administering the Vermont All-Payer ACO Model.”
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
Prices for care at hospital trauma centers vary across hospitals; drug shortages reached a record high during the first quarter of 2024; although 3 of the biggest makers of asthma inhalers pledged to cap out-of-pocket costs for some US patients at $35, these do not apply to daily inhalers used by the youngest kids with asthma.
Read More
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen
The Biden administration recently launched the Global Health Security Strategy, a new effort to combat the spread of infectious diseases; lawmakers zeroed in on the risks of massive consolidation in health care during the first congressional hearing on the Change Healthcare hack; the FDA recently announced the recall of a pair of heart devices linked to numerous deaths and injuries.
Read More