CMS releases evaluation of Vermont all-payer model, with promising early results
The APM achieved statistically significant Medicare gross spending reductions at both the ACO and state levels.
Photo: Joseph Sohm/Getty Images
The Centers for Medicare & Medicaid Services has released an evaluation and summary of findings of the first two performance years – 2018 and 2019 – of Vermont's All-Payer Model.
These found promising results, indicating the APM and Vermont's Accountable Care Organization, OneCare Vermont, are on the right track toward changing the way healthcare is paid for and delivered.
The evaluation of the first two years of the model was conducted by NORC at the University of Chicago, an independent research institution, and assesses the implementation and measures effects of the APM.
WHAT'S THE IMPACT?
The five-year APM was launched on January 1, 2017 with the purpose of assessing whether an All-Payer Model to include Medicare, Medicaid, and commercial payers, and implemented by a statewide ACO, could reduce healthcare spending while preserving or improving quality of care.
OneCare Vermont is the statewide ACO and has worked to meet the goals outlined in the APM by aligning payments to providers with incentives that improve care and overall population health, especially for those with chronic or complex illness. The program also enhances coordination among providers, provides data to support best practices to make care more consistent, and invests in wellness and prevention through primary care.
Among the key findings of the evaluation are that the APM achieved statistically significant Medicare gross spending reductions at both the ACO and state levels, as well as Medicare net spending reductions at the state level.
Additionally, there were statistically significant declines in acute care stays (at the ACO and state levels) and in 30-day readmissions at the state level.
Evaluators also found that stakeholders agree the APM provides an important, unifying forum for providers, payers and the state to engage in meaningful discussions about healthcare reform and set goals. The APM is also strengthening relationships among hospitals, community organizations, designated mental health agencies, primary care practices and other providers.
Several areas of opportunity identified in the report have been addressed in years three and four of the APM, including bringing more Federally Qualified Health Centers into the ACO and committing further investment and support for independent primary care.
THE LARGER TREND
OneCare Vermont received federal approval in 2016 as a way to control the cost of healthcare.
Its extensive network of providers includes several of the state's hospitals, two neighboring New Hampshire hospitals, hundreds of primary and specialty care physicians, rural health clinics, and others facilities, coordinating the healthcare of approximately 102,000 combined Medicare, Medicaid and commercial exchange beneficiaries
ON THE RECORD
"These findings are very encouraging validation of the critically important work our providers are doing to improve preventive care, keep costs down, and support patients with complex conditions," said OneCare CEO Vicki Loner. "We have a long way to go to fully realize the vision of the APM, but we are on the right track and must continue to make steady progress for the people of Vermont."
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
