As OneCare Winds Down, Vermont Looks AHEAD
In November, OneCare Vermont (OCV), an accountable care organization dedicated to improving Vermont’s healthcare system, announced that it would wind down its operations at the conclusion of 2025.
This decision comes as the Vermont All-Payer ACO Model (VTAPM), a state-led initiative designed specifically for Vermont, is set to conclude at the end of the calendar year 2025.
Vermont is one of the early states participating in the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, which will hold participating states accountable for controlling overall growth in healthcare expenditures and improving population health outcomes.
As Healthcare Innovation reported in December 2022, one big blow to the OCV effort came just after the Center for Medicare & Medicaid Innovation published its second evaluation report on Vermont’s All-Payer ACO Model, when the nonprofit Blue Cross and Blue Shield of Vermont announced it would pull out of OCV for the 2023 plan year.
At the time, Blue Cross put out a statement saying that despite having collaborated with OCV every year since its inception, it was unable to reach an agreement that year “due to the lack of tangible quality outcomes, inability to bend the cost curve, and the new data approach that introduces concerns about security and privacy.”
According to a 2022 news story on VTDigger, the withdrawal of Blue Cross “cuts the number of Vermonters enrolled in OneCare’s portfolio by around 93,000 people, roughly one-third of its total, and brings the amount of healthcare spending under contract with the ACO down by the same percentage, according to estimates for 2023 by the Green Mountain Care Board.”
The CMMI evaluation that year found that although the pandemic and a cyberattack on the University of Vermont Health System posed unique challenges in 2020, the Medicare ACO initiative continued to reduce spending and utilization in payment year 3 relative to a comparison group. The initiative also continued to see progress toward population health improvement goals.
OCV said the organization has also played a crucial role in stabilizing primary care through its population health programs and Comprehensive Payment Reform (CPR) program for independent primary care practices.
In its final operational year, OneCare said it is committed to supporting its participant network in achieving shared cost and quality goals. The organization said it intends to maintain consistency for participants during the last year of the Vermont All-Payer Model. All programs, investments, and waivers will operate as previously planned to facilitate a smooth transition as participants explore future opportunities for 2026.
“Throughout a challenging reform environment, OneCare has successfully united providers across the continuum of care to pursue common goals,” said Anya Rader Wallack, OneCare board chair, in a statement. “This effort built upon a long history of successful Vermont health care reform programs, and I feel confident the foundation we’ve established will serve as a strong basis for future innovations. On behalf of the board I want to thank the resourceful team at OneCare for their dedication to this important work.”
With the AHEAD Model, CMS will issue agreements to each participating state, which could receive up to $12 million from CMS during the first five and a half years of the model to support implementation.
The AHEAD Model is scheduled to operate for a total of 11 years, from 2024 through 2034.
Under a total-cost-of-care approach, a participating state uses its authority to assume responsibility for managing healthcare quality and costs across all payers, including Medicare, Medicaid, and private coverage. States also assume responsibility for ensuring health providers in their state deliver high-quality care, improve population health, offer greater care coordination, and advance health equity by supporting underserved patients.
The AHEAD Model will provide participating states with funding and other tools to address rising health care costs and support health equity. But the model also holds states accountable for state-specific Medicare and all-payer cost growth and primary care investment targets, and for population health and health equity outcomes.
Vermont sees the AHEAD model as a way to collaborate with the federal government to impact how Medicare, the insurer for 21 percent of Vermonters, pays hospitals, supports primary care, improves health equity, and allows flexibility in how care is delivered.
