VT – State All-Payer ACO Model to Kick Off with Medicaid Pilot

March 2017~

CMS has granted a broad-based waiver to Vermont which gives the state the authority to initiate an all-payer accountable care organization (ACO) pilot aimed at serving 30,000 of the state’s 190,000 Medicaid beneficiaries in 2017. If successful, the program would be expanded to encompass the rest of the state’s Medicaid population as well as commercial and Medicare lives.

During the program’s pilot phase set to begin in 2017, Medicaid patients will receive care, under a set budget, through an organization called OneCare Vermont. OneCare’s network of hospitals and doctors already provide care to about 100,000 Vermonters.

The state will provide monthly payments to OneCare, totaling in $93 million, for the care of the 30,000 Medicaid patients ($3,100 per beneficiary). OneCare will be responsible for any costs exceeding the allotted amount. If OneCare spends less than that amount, the savings will be shared with the state.

“We want to simplify how things work, with both coverage and access to care. We want to enhance competition and we want to lower cost growth even as we improve quality,” Said Al Gobeille, Vermont’s secretary of Human Services.

“This tests the concept of a global budget and streamlined payment which incentivizes better care,” says Todd Moore, OneCare’s CEO. “We may be a small state but we are trying a big thing. If it works, many states are likely to stand up and take notice.”

Source(s): Kaiser Health News, February 2017; Vermont Watchdog, March 2017; Legislature.vermont.gov, March 2017; Scribe America, March 2017; AHA, March 2017; Center for Health Care Strategies, March 2017;