Is Vermont Ushering In One Version of Healthcare’s Future?

Feb. 11, 2014
A recent article in an ACO-focused newsletter sheds light on the tremendous advances being made in collaborative healthcare delivery and financing in Vermont, as leaders in the Green Mountain State move forward rapidly in the context of the creation of a single-payer health system there.

An article published by AIS Health and reprinted from ACO Business News under the headline “ACOs Gain Wide Traction in Vermont as State Eyes Move to Single-Payer in 2017,” provides a fascinating glimpse of the fast-track future being built in the Green Mountain State. As the article notes, “Vermont is pushing full speed ahead on accountable care initiatives in both public and private health insurance markets as it experiments with cost-control measures to prepare for a shift to a single-payer system planned for just three years from now.”

The article goes on to note that “The state is in the final stages of contracting with two ACOs—OneCare Vermont, an ACO formed as a collaboration of Fletcher Allen Health Care and Dartmouth-Hitchcock, and Community Health Accountable Care LLC, a coalition of federally qualified health centers—to participate in a new Medicaid ACO program,” according to Kara Suter, director of payment reform for the Department of Vermont Health Access. What’s more, the state already has three accountable care organizations active in the Medicare Shared Savings Program (MSSP) for ACOs:  the Accountable Care Coalition of the Green Mountains, started in July 2012; OneCare, which opened in January 2013; and Community Health Accountable Care LLC, starting in 2014.

The article goes on to quote healthcare provider executives eager to get in on the action, as the state transitions to a single-payer health insurance system in 2017. Now, realistically, it is unlikely that too many states will follow Vermont’s lead in precisely the same way. After all, Vermont is a very liberal state legislatively, and also has a very small, widely dispersed population, and little genuine poverty. In all those ways, it actually resembles some of the Nordic countries (Norway, Sweden, Denmark, Iceland, and Finland) more than it does many of the large, diverse states in the U.S.

But what could be replicable from Vermont is this: a broader sense of collaboration among all stakeholder groups, as we in U.S. healthcare move forward to create not only specific accountable care organizations, but “accountable care” in the very broadest sense, in our healthcare industry. And because the Vermont healthcare community already has decades of experience with collaboration, what the Vermonters are learning could prove invaluable to healthcare leaders in other states.

One key element in all this, I’m certain, will be health information exchange. Fortunately, the Vermonters are already way ahead of the game on that front, too, with a statewide HIE that is up and functioning, and has the participation of virtually all the hospitals and most of the practicing physicians, in that state. The clinical data that is already beginning to be exchanged will of course be crucial to the success of all the initiatives going forward there, particularly in the context of a single-payer health system.

It will be fascinating to see how all this plays out in the next couple of years in Vermont. And to those naysayers who will immediate cite some of the uniquenesses of that state and its healthcare environment, I would say “not so fast”—what happens in Vermont may not necessarily just stay in Vermont. And I look forward to hearing from healthcare and healthcare IT leaders in the Green Mountain State in the next few years, as they create one version of healthcare’s future, in an environment that could prove to be a true “learning lab” for healthcare leaders nationwide.

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