Through Vermont's earlier "Blueprint for Health" initiative for chronic care patients and the state's collaboration with the Dartmouth Population Health Research Center," Vermont has been exploring additional sets of population health based measures for its ACO pilots, Hester notes.
Any ACO pilot also will need to have threshold capabilities in five areas to get started, the report said.
In addition, Vermont has an all-payer claims database that all commercial payers already are "syncing into a common system" and then generating reports, Hester notes.
But what will the ACOs eventually look like? Probably if you're seen one pilot ACO in Vermont—you've seen one. Achieving the necessary critical mass of patients that would support statistically meaningful measures of performance may require either a consolidated performance pool involving multiple payers—or expanding the ACO to include multiple hospitals.
The former is more likely, Hester says. "You'll need a certain critical mass in order to make the shared savings pools work," Hester says. It probably would have to be in the area of at least 15,000 patients. The latter could greatly complicate implementation issues, particularly governance. "We have a lot to learn and a lot of experimentation [to do] in terms of what kind of structures it can support, Hester says.