Payment Reform Unit

# of Medicaid members per month for whom a prospective payment was made to OneCare Vermont from DVHA as part of the Vermont Medicaid Next Generation (VMNG) ACO program

112,997Jul 2022

Line Bar
Notes on Methodology

Partners
  • Gainwell Technologies
  • OneCare Vermont
Story Behind the Curve

This measure is important because it reflects the scale and scope of the Vermont Medicaid Next Generation (VMNG) Accountable Care Organization (ACO) program. The VMNG ACO program is an important component of Vermont’s All-Payer ACO Model Agreement with the federal Centers for Medicare and Medicaid Services. 

This measure shows the number of Vermont Medicaid members attributed to OneCare Vermont, the ACO that is participating in the VMNG ACO program, by month. The data is broken down by whether the member is attributed to the ACO through the traditional attribution methodology (where members demonstrate past utilization with a primary care provider [PCP] in the program) or the expanded attribution methodology (where members don’t demonstrate past utilization with a PCP in the program but have a full Medicaid benefits package and no other insurance).  

Medicaid member attribution to the VMNG ACO program is set prospectively (at the beginning of a performance year), and no new members are added to the population during a performance year. Prospectively attributed members may be considered ineligible for attribution in a given month due to a number of factors, including eligibility changes (e.g. loss of Medicaid coverage); evidence of an additional source of insurance coverage or ageing into Medicare eligibility; death; or termination of a contractual relationship between an attributing provider practice and the ACO (at which time all members that had been attributed through that practice are no longer considered attributed to the ACO). Some members may subsequently become eligible for attribution again after losing eligibility in an earlier point in the year, but a 1-1.5% decrease in the number of PMPM payments made is expected month-to-month in a given program year. The trendline shows that from year to year, attribution is increasing as more providers join the ACO. 

Narrative last updated:  12/22/2020

Strategy

In order to meet its obligation under the State’s All Payer Model Agreement with the Centers for Medicare and Medicaid Services (CMS), which sets forth scale targets for the number of Vermonters aligned with an ACO, in 2020 the VMNG ACO program implemented an innovative statewide expanded attribution initiative. Through this modified attribution methodology, Medicaid members who could not be attributed based on office visits with primary care providers participating in the ACO were attributed based on whether they had a full Medicaid benefits package and no demonstrated relationship with a non-ACO PCP.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy