Vermont all-payer ACO shows early success

Source: Healthcare DIVE, Les Masterson, May 15, 2018

Dive Brief:

  • new Commonwealth Fund report  found OneCare Vermont’s all-payer accountable care organization (ACO) model is finding success by pushing the state’s three largest payers — Medicare, Medicaid and Blue Cross and Blue Shield of Vermont — to speed up the move from fee-for-service to risk-based contracting.
  • Early results for the ACO show high-risk Medicaid beneficiaries in the program are using primary care, behavioral health and pharmacy benefits more when compared to other beneficiaries. The percentage of beneficiaries with early to late-stage disease who didn’t have a primary care visit fell from 4% to 2%. Emergency department visits and hospitalizations also dropped during the first nine months of the contract.
  • Meanwhile, the federal government approved Maryland’s request to expand its all-payer model. Beginning in January, across-the-board rates in the state will include hospital and non-hospital settings. This could include physician offices and nursing homes.
 Dive Insight:

OneCare Vermont, which partnered payers, providers and community organizations “may offer lessons about the potential of care coordination to wring value out of a fragmented healthcare system,” according to the case study.

The Commonwealth Fund said Vermont’s small size helps the ACO because it “engenders trust and familiarity among health system leaders and policymakers.” There’s also a lack of private payer competition, which benefits the all-payer project.

OneCare Vermont signed up more than half of the state’s physicians and nearly all of its hospitals within its network, which increased the number of patients in risk-based contracts and provided financial support to coordinate care for high-risk patients.

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Source: Healthcare DIVE, Les Masterson, May 15, 2018