This measure is important because the DVHA Payment Reform Unit supports the CMS goal to accelerate the percentage of US health care payments tied to quality and value through the adoption of two-sided risk alternative payment models. These are: 

1. Models built on fee for service (FFS) architecture with shared savings and downside risk (category 3 in the snip above; currently Vermont has no category 3 models).
2. Models which involve prospective, population-based payments, structured in a manner that encourages providers to deliver well-coordinated, high-quality person-centered care within either a defined scope of practice, a comprehensive collection of care, or a highly integrated finance and delivery system (category 4 in the snip above; currently Vermont has two subcategories of category 4 models: condition-specific population-based payment and comprehensive population-based payment).

The summary for CY2023 was completed in early August. Fee for Service (FFS) showed a decrease from CY2022 of $61,676,937. FFS w/link to quality & value was newly included in the CY2023 data due to the inclusion of the High-Tech Nursing payment reform payment model. The 0% of total dollars is rounded from an actual of .1%. We have no APMs built on FFS, based on the Learning Action Network definition of APMs. Lastly, the population-based payment of $1,266,773,394 is the total of $372,491,408 (Condition-specific population-based payments) and $894,281,986 (Population-based payments that are not condition-specific). The data shows a decrease in FFS health care spending and increase in population- based payments, driven primarily by the Vermont Medicaid Next Generation ACO program. 

Narrative last updated: 08/20/24

• Blueprint
• DVHA Business Office
• Catalyst for Payment Reform
• Centers for Medicaid & Medicare Services (CMS)
• Healthcare Performance Learning & Action Network (HCPLAN)

DVHA will continue to move away from fee for service (FFS) and towards models tied to quality and value through the adoption of two-sided risk alternative payment models. The scorecard reflects the advancement made by Vermont Medicaid to achieve these goals.