The State of Vermont is planning to ask the Centers for Medicare & Medicaid Services for a one-year extension to its All-Payer Accountable Care Organization Model Agreement, during which time it will work toward developing a proposal for a subsequent five-year agreement.
The current agreement is scheduled to end on Dec. 31, 2022. In a draft proposal published on the VTDigger newspaper website, the state explained that its current model relies on strong collaboration between government, payers, and providers.
“The COVID-19 public health emergency prevented Vermont from fully testing the current Model in 2020 and 2021. An additional year may allow Vermont to more completely finish the Model test, depending on how the pandemic evolves,” the proposal states. “Thoroughly engaging these partners will be a critical step in developing a proposal for a subsequent agreement and was planned for 2020. The COVID-19 public health emergency, however, has delayed and may continue to delay this work as these partners focus on the response to COVID-19."
In addition, Vermont proposes to work with the Center for Medicare & Medicaid Innovation during this time to evolve the Vermont Medicare ACO Initiative’s payment model toward unreconciled population-based payments.
Vermont says it hopes to build on lessons learned from the Vermont Medicaid Next Generation ACO Program in the near future, including the unreconciled population-based payment model – but needs additional time to develop a proposal for a longer-term agreement with meaningful stakeholder input. Vermont proposes to work with Medicare on this change under the current agreement, while simultaneously developing a proposed subsequent model.
VTDigger’s news report says that the Green Mountain Care Board is expected to endorse the proposal later this month, and negotiations on a new five- or six-year agreement would begin soon after federal officials approved the one-year agreement.
It also notes that Vermont has consistently fallen short of the targets set in the 2016 agreement. “State leaders committed to having 70 percent of all Vermonters participating in the all-payer model by the end of 2022, but only 57 percent are enrolled so far, according to Vermont’s most recent report to the Centers for Medicare and Medicaid Services.”
In 2008, Vermont launched a patient-centered medical home transformation effort and community health teams were piloted in three hospital service areas supported through capitated payments. In 2011, there was a statewide expansion of community health teams to all hospital service areas. Patient-centered medical homes and community health teams continue as foundational elements of All-Payer ACO Model, he added.
The Green Mountain Care Board (GMCB) was originally created to oversee a publicly financed single-payer health care system, but that plan was dropped when the tax increases required to fund it were deemed too high. But the GMCB continues to oversee hospital budgets, commercial payer rates, ACO budgets, and the financial impact of the All-Payer ACO Model agreement with CMS.
The state’s reform goals remain to control healthcare spending; move from a fee-for-service system to one that pays for volume; and to create a value-based system that allows for investments to keep the population healthier.
The all-payer model enables Medicaid, Medicare and commercial payers to pay an ACO (called OneCare Vermont) differently than through fee-for-service reimbursement. A CMS waiver allows Medicare’s participation. Hospitals are starting to receive a fixed, pre-determined all-payer fee for all necessary services, and currently all Vermont hospitals are voluntarily participating.
