All-Payer Model Agreement and Justification

Information and Background

The rate of growth in health care spending is not sustainable and is a direct contributor to the affordability crisis of Vermonters, who struggle to access preventive and primary care services. While the GMCB has been successful in beginning to curb health care cost growth (i.e. the GMCB reduced the system-wide increase in net patient revenue from 4.6% to 4.3%, totaling $7.3 million in one year) there is still much work to do. The APM, an agreement between the federal government and the State of Vermont, is an attempt to further this work and seeks to evolve the way we deliver care by incentivizing cost and quality of care in Vermont with the goals of increasing access to primary care, reducing deaths due to suicide and drug overdose, and reducing the burden of chronic disease.

The All-Payer ACO Model is a care model that pays differently for health care by rewarding improved provider communication and patient outcomes over volume of services to improve the lives of Vermonters. It is a voluntary network of health and social service providers work together with the Accountable Care Organization (ACO) to improve the health of Vermonters by providing the right care, at the right place, and at the right time. Shifting from fee-for-service to value-based payments provides an opportunity to change the emphasis from seeing patients more routinely for episodic illness to providing preventive care over a lifespan. Participating health care payers in the APM include Medicare, Medicaid, and commercial. The APM is facilitated by a five-year agreement with the Centers for Medicare and Medicaid Services (CMS), from 2018 to 2022 and includes the following signatories: CMS, the GMCB, Vermont’s Agency of Human Services, and the Governor. 

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