It is critically important that we measure the Vermont Medicaid Health Care paid for via the alternative and value-based payments. This process contributes to the acceleration of payments tied to quality and value, categories 3B and 4 of the HCPLAN Alternative Payment Model (APM) Framework. The Vermont data not only offers information from our own State’s efforts but, it helps us measure our performance against national data: since 2016, we have contributed to a national effort to assess the adoption of APMs over time and track progress towards an increased percentage of value-based payments.

The 2 key performance measures are fee for service (FFS) payments, for which we should see a continued reduction in percentage of total, and population-based payment, for which we should see a continued increase in percentage of total. The shift away from FFS is needed to effectively transition toward payment mechanisms that are better designed to promote the triple aim of healthier people, better care, and smarter spending.

Population-based payments are better suited than FFS payments to support the valued care delivery and incentivize the positive outcomes. The Vermont CY 2024 data tell us that the percentage of Vermont’s population-based payments continues to increase, from 76% in CY 2023 to 86.3% in CY 2024 (as percentage of total spending). However, the dollar value of the population-based payments has decreased since prior year. Redeterminations, in part, reshaped DVHA spending; a resulting loss of ACO enrollment was noted. While ACO lost enrollment, the loss in enrollment tended to be people who had lower overall spending resulting in a PMPM spending increase in both capitated payments and in ACO FFS spending. 

The percent of FFS payments has continued to decrease, from 24% in CY 2023 to 13.6% in CY 2024 (as percent of total spending). 

Narrative last updated: 11/6/2025
 

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

DVHA plans to continue to participate in the national data collection effort via a collaboration between AHIP Blue Cross Blue Shield Association. Vermont will continue to measure our move away from fee for service and towards models tied to quality and value.