Despite Early Success, Vermont’s All-Payer Waiver Faces Persistent Implementation Challenges: Lessons From The First Four Years

Health Affairs January 5, 2021
Adam Atherly, Eline van den Broek-Altenburg, Stephen Leffler, Claude Deschamps

In 2016, Vermont was granted a Centers for Medicare and Medicaid Services (CMS) all-payer model (APM) waiver, which allows accountable care organizations (ACOs) in the state to receive payments from Medicare, Medicaid, and commercial insurance and then align payments and quality measures for providers. The APM may be a viable health care reform model for many states because it offers many of the theoretical advantages of single-payer–type systems—economies of scale, aligned incentives, and potentially reduced administrative costs—without tax increases or public provision of services.

The APM eliminates distinctions between payer sources, theoretically allowing providers to synchronize care and create care efficiencies. The goal of the waiver is to shift the entire state from a fee-for-service payment model to a...

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