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About Vermont's All-Payer Model

Vermont’s All-Payer Model (APM) 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 health of Vermonters.

The Vermont All-Payer ACO Model Agreement

Vermont’s All-Payer Accountable Care Organization Model Agreement is a five-year (2018-2022) arrangement between Vermont and the federal government that allows Medicare to join Medicaid and commercial insurers to pay differently for health care. The goal of the APM is to shift payments from a fee-for-service system that rewards the delivery of high-volume high-cost services, to a payment system based on value, high quality care and good health outcomes at a lower cost. The APM Agreement is signed by the Governor, the Secretary of the Agency of Human Services (AHS), and the Chair of the Green Mountain Care Board (GMCB). These parties work together to implement the Agreement.

Increasing Value for Vermonters

Shifting away from fee-for-service toward value-based payment rewards high performance and good outcomes. This change in incentives helps Vermonters connect to the right care, at the right place, at the right time. By shifting the focus to preventive care, the APM urges providers to catch and treat small health problems before they turn into big issues, and incentivizes increased communication and coordination between health care and social service providers, especially those who are caring for the sickest or highest-risk patients. When providers and payers work toward an aligned set of quality measures, with a shared accountability for the cost and quality of care, health care and health outcomes only stand to improve for all Vermonters.

Ensuring Engagement Across the Health Care System

An Accountable Care Organization (ACO) is a voluntary network of health care providers that agree to be accountable for the care and cost of a defined population of patients. The Affordable Care Act (ACA) included incentives for creating Medicare ACOs because they were identified as a promising way to reduce the ever-rising cost of health care nationwide. Vermont’s APM was designed to change health care payment models, curb health care cost growth, maintain quality of care, and improve the health of Vermonters, using ACOs as the vehicle for change. OneCare is currently the only multi-payer ACO operating in Vermont, though the APM does not preclude more than one ACO operating in the state. Vermont’s ability to achieve the goals of the APM relies on robust participation and collaboration among partners across the delivery system — from state agencies, health care providers, payers, employers, and others that support health care transformation.

Measuring Success

Vermont’s All-Payer Model Agreement aims to align health care cost growth with the growth of the Vermont economy and to improve the health of Vermonters over time. It sets ambitious goals and benchmarks that will be measured over 5 years. The outcomes the APM sets out to achieve require significant upfront investment, effective management, robust engagement, ongoing tracking, and possible model adjustments and improvements along the way. The Agreement outlines three types of targets for Vermont:

  • 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. As data for each year of the APM becomes available, we are tracking performance against these benchmarks and carefully evaluating our progress, knowing that moving the needle on population health is a long-term effort. In line with the Board’s purpose to provide transparency, we will share results on the state’s progress with the public as they become available.
  • We also track how many providers and Vermonters are participating in the model.

Early results show that provider participation steadily increased throughout Years 1-3. The growth in health care costs was 4.1% in Year 1 (2018) and 4.6% in Year 2 (2019); while the Year 2 growth rate exceeds the target range, it represents a decline from the 2017 growth rate (8.5%). As of Year 2, Vermont is seeing improvement in the majority of the 22 reported measures – and meeting or exceeding five of the Agreement’s six population health outcome targets.

For a summary of Vermont’s progress toward achieving the All-Payer Model Agreement targets, see Vermont's All-Payer Model Performance Summary Dashboard. You can review all APM reports on the APM Reports and Federal Communications page.