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About the All-Payer Model


Vermont’s All-Payer Model is changing the way health care is delivered and paid for, with the goal of keeping the state’s health care spending in check and improving the quality of care Vermonters receive. It gives health care providers the flexibility to provide services like telehealth, group visits, and coordination with fellow providers that were previously not billable. And it holds insurers and providers jointly accountable for the quality and cost of care they provide to Vermonters. The Model pays for care based on value not volume, driving improved outcomes and enhancing the quality of care. It encourages increased communication and coordination between health care providers, especially those who are caring for the sickest or highest-risk patients. It helps ensure Vermonters are connected to the right care, at the right place, at the right time. And by shifting the focus to preventive care, the Model helps patients catch and treat small health problems before they turn into big issues.

The Model is working to ensure the cost of care doesn’t outpace growth in Vermont’s economy and to improve the health of Vermonters over time. It has set ambitious goals and benchmarks that will be measured over 5 years and beyond. The outcomes we’re trying to achieve require significant upfront investment, effective management, robust engagement, ongoing tracking, and adjustments and improvements along the way:

  • Through the Model, we are tracking health care spending across 5 years, with the goal of keeping the average increase in costs to 3.5% – and no more than 4.3% – between 2018 and 2022. We’ll be evaluating our goal over a 5-year period as we expect health care utilization and costs to fluctuate year-to-year.
  • One of the most ambitious goals of the Model is to improve the health of Vermonters over time. Specifically, the Model aims to increase access to primary care, reduce deaths from suicide and drug overdose, and lower prevalence of chronic disease. These measures were informed and shaped by stakeholders throughout the state. We have achieved the first step of establishing baselines for each of these goals, and we have results from the Model’s first year (2018). As data for each subsequent year of the Model becomes available, we will track against these benchmarks, carefully evaluate our progress, and make adjustments as we learn what works along the way, knowing that moving the needle on population health is a long-term effort. We will also transparently share results with the public as they are available.
  • We also track how many providers and Vermonters are participating in the model.

Early results suggest we are headed in the right direction. Provider participation steadily increased throughout Year 1. Though the growth in health care costs was 4.1% in Year 1 (see APM Total Cost of Care Annual Report for 2018), it represents a decline from the previous year (8.5%) and is below the 4.3% that would trigger corrective action from CMS. As more providers come on board, and the changes to their business models begin to take hold, we expect to see continued progress towards our 5-year growth target. To learn more about results to date, see Vermont's All-Payer Model, Results to Date: Performance Year 1 (2018). You can review all APM reports on the APM Reports and Federal Communications page.

The Vermont All-Payer ACO Model Agreement

The All-Payer Accountable Care Organization Model Agreement (sometimes referred to as the All-Payer Model, APM, the “Model”, or the “Agreement”) is a five year (2018-2022) agreement between Vermont and the federal government that allows Medicare to join Medicaid and commercial insurers to pay for health care in a different way. New payment models change incentives to reward improved provider communication and patient outcomes to improve the lives of Vermonters, and pay for value in health care rather than volume. The goal of the APM is to shift from a fee-for-service system to a population-based payments system while improving population health outcomes for Vermonters and limiting the health care cost growth to historic state economic growth.