In conjunction with the state of Vermont, CMS announced the Vermont All-Payer Accountable Care Organization (ACO) Model on Wednesday. The new model is the first of its kind and represents an advancement in the goal of redesigning the healthcare delivery system with an emphasis on high-value care and improved health outcomes.
In conjunction with the state of Vermont, CMS announced the Vermont All-Payer Accountable Care Organization (ACO) Model on Wednesday. The new model is the first of its kind and represents an advancement in the goal of redesigning the healthcare delivery system with an emphasis on high-value care and improved health outcomes.
A key mission of the All-Payer ACO Model is to increase participation in ACO programs, with the goal that 70% of all insured Vermont residents will be included in an ACO by 2022. Participation by payers and providers is voluntary, but CMS and Vermont will encourage all to join the Medicare and Medicaid ACO Initiatives tailored to the state. In 2017, CMS will designate $9.5 million as “start-up funding” to support Vermont providers as they improve care coordination, build connections with community-based care providers, and enact practice transformation efforts.
“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,” Patrick Conway, MD, CMS principal deputy administrator and chief medical officer, said in a press release.
The Vermont Medicare ACO Initiative qualifies as an Advanced Alternative Payment Model (APM) under the CMS Quality Payment Program (QPP). As early as 2018, participating providers could be eligible to receive the Advanced APM bonus payments. According to a QPP fact sheet, Advanced APMs are encouraged because they incentivize high-quality care by having providers take on financial risk based on patient outcomes.
Vermont Governor Peter Shumlin announced in a press release that “by shifting the focus away from the current fee-for-service system to one that rewards primary care and prevention,” the agreement made Vermont the first state “to fundamentally transform our entire healthcare system so it is geared towards keeping people healthy, not making money.”
The All-Payer ACO Model also incentivizes collaboration between delivery and public health systems. Vermont has identified 4 areas they see as priorities in achieving Healthcare Outcomes and Quality of Care targets: substance use disorder, suicide, chronic conditions to care. The achievement of these targets will be the basis of the Population-level Health Outcomes measure category, which joins Healthcare Delivery System Measures and Process Milestones as the categories of metrics by which Vermont’s success will be evaluated.
The terms of the All-Payer ACO Model were approved by the Green Mountain Care Board (GMCB), the independent organization that since 2011 has been responsible for developing and implementing healthcare payment and delivery system reforms in the state of Vermont. In Wednesday’s announcement, CMS said that GMCB would be “a key partner in administering the Vermont All-Payer ACO Model.”
Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
Listen
How Access to SMA Treatment Varies Globally and by Insurance Type
March 18th 2025Posters presented at the 2025 Muscular Dystrophy Association (MDA) Clinical & Scientific Conference show that therapeutic advances in treating spinal muscular atrophy (SMA) are not uniformly making it into the hands of patients who could benefit.
Read More
Value-Based Care Is Key to Bringing Cardiology Breakthroughs to Those Who Will Benefit Most
March 13th 2025On December 10, 2024, cardiologists, researchers, and value-based care experts gathered in Dallas, Texas, to discuss best practices for implementing advances in cardiology care with a value-based mindset, spanning the care continuum from prevention to treatment.
Read More