Vermont tests payment model, rewards docs who keep Medicaid patients well

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An accountable care pilot program in Vermont will be tested with about 30,000 Medicaid patients. (Getty/DenisTangneyJr)

Vermont will test a new accountable care pilot program that rewards providers who do more to keep Medicaid patients healthy instead of paying them to treat patients after they are already sick.

The pilot, estimated to cost $93 million in state and federal funds, will be tested with about 30,000 Medicaid patients in the state, according to an Associated Press article via the Burlington Free Press. The Medicaid enrollees involved in the pilot will come from parts of the state served by four community hospitals: Porter Medical Center in Middlebury, The University of Vermont Medical Center in Burlington, Northwestern Medical Center in St. Albans and Central Vermont Medical Center in Berlin.

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“It will allow providers to dedicate more time and energy to patients by eliminating some of the time doctors and administrators spend on claims,” Gov. Phil Scott told the AP.

Participating providers will partner with the accountable care organization OneCare Vermont on the pilot. The ACO will pay each provider a set fee per patient, and those that spend more will have to make up the difference themselves. Providers that spend less than the allotted fee will profit, according to the article.

The new model has been in the works since last fall under Vermont’s previous governor, Peter Shumlin. His administration worked with the Centers for Medicare & Medicaid Services to draft an agreement for an all-payer model, similar to one in place in Maryland.

The rollout across the state will be slow, officials have said. The plan is to be active in approximately 40% of care services by the program’s second year and hit about 70% by year six. The program’s designers are confident that it could become a national model for similar payment reform. And should the pilot not prove fruitful, Vermont can exit its agreement with the CMS without penalty.