The architects of Vermont’s new value-based payment model believe it could serve as a blueprint for payment reform across the country by focusing on quality care, reducing healthcare costs and improving access to care.
In a post on HealthAffairsBlog, members of the Green Mountain Care Board who led efforts to implement the Vermont All-Payer Accountable Care Organization (ACO) Model outline reasons why the state-based program could lead to a broader shift, highlighting the program's incremental approach to participation and its targeted focus on specific areas of care. Although Maryland initiated an ACO-based model in 2015, Vermont took the additional step of extending its model to a broader range of providers and payers.
The authors point out that the state incentivized providers to joint the ACO by minimizing administrative burden and outlining predictable reimbursement models. The system focuses on paying providers for quality rather than quantity and cutting down on unnecessary procedures identified through the Choosing Wisely campaign. The program includes specific goals for improving access to primary care, reducing suicides and drug overdoses, and treating chronic illnesses.
The ACO model does not impose benefit restrictions on patients, but it does focus on enhancing coordinated care and allowing providers the freedom to make decisions at a localized level. The program also has a built-in fail safe: If Vermont fails to meet financial targets or population health goals, the state can exit its agreement with the federal government without penalty.
“Approval of the All-Payer ACO represents a monumental and potentially transformational shift in healthcare in the state of Vermont,” the authors write. “Nevertheless, the hard work of implementation lies ahead and will require continued statewide conversation, collaboration and compromise.”