The $9.5M, six-year initiative aims to get 90% of Vermont Medicare beneficiaries in an ACO by 2022.
In an effort to broaden accountable care organization (ACO) participation throughout Vermont, the state has teamed up with the Centers for Medicare & Medicaid Services (CMS) to develop an All-Payer ACO Model, CMS announced this week.
Under the program, set to begin January 1, major payers throughout the state—Medicare, Medicaid, and commercial healthcare payers—will incentivize healthcare value and quality under the same payment structure for the majority of providers throughout the state's care delivery system.
In particular, Vermont has prioritized outcomes surrounding substance use disorder, suicides, chronic conditions, and access to care.
The voluntary program will provide Vermont clinicians startup funding of $9.5 million to help them bolster care coordination and collaboration. Meanwhile, CMS has approved a five-year extension of Vermont's section 1115(a) Medicaid demonstration, enabling Medicaid to be a full partner in the new ACO.
Healthcare Access Study Ranks Best, Worst States
“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,” said Patrick Conway, MD, CMS principal deputy administrator and chief medical officer.
Vermont's ACO will build on a three-year-old all-payer model in Maryland. CMS officials expect to work closely with Vermont's Green Mountain Care Board to help providers, including physicians in small practices, to succeed under the value-based system.
Importantly, the Vermont Medicare ACO Initiative is considered a Medicare Advanced Alternative Payment Model (APM) for the providers in the two-sided risk Medicare ACO portion of the model within CMS's Quality Payment Program, meaning that participating clinicians may qualify for the advanced APM bonus payments starting in performance year 2018.
The program will end on December 31, 2022, by which the state aims to have 70% of all insured residents, including 90% of Vermont Medicare beneficiaries, attributed to an ACO.
The state is also planning to limit its annualized per capita healthcare expenditure growth for all major payers to 3.5%, and limit Medicare per capita healthcare expenditure growth for Vermont Medicare beneficiaries to at least 0.1–0.2 percentage points below that of projected national Medicare growth.