Payment Reform Unit

# of Medicaid members impacted by payment reform projects

135,312Mar 2022

Line Bar
Notes on Methodology

Partners
  • OneCare Vermont ACO and many providers
  • Green Mountain Care Board
  • Department of Mental Health
  • Vermont Department of Health
  • Department of Disabilities, Aging and Independent Living
  • DVHA Quality Improvement and Clinical Integrity Unit
Story Behind the Curve

This measure is important because it shows the range, scale, and impact of DVHA’s value-based care initiatives.

The DVHA Payment Reform Unit is engaged in a number of projects designed to address the triple aim of reducing growth in health care costs, improving care, and improving the health of the population. Projects include the Vermont Medicaid Next Generation (VMNG) Accountable Care Organization (ACO) program (featuring all-inclusive population based payments), the Adult and Children's Mental Health project (a case rate model), the Residential Substance Use Disorder project (episodic payments), the Applied Behavior Analysis autism benefit project (monthly bundled payments), the Brattleboro Retreat (inpatient per diem payments), High-Technology Nursing (a hybrid monthly and FFS payment), and the Children’s Integrated Services project (prospective monthly bundled payments).

The data presents two views of the information:

  1. A count of Medicaid members impacted by payment reform. Members may be impacted by more than one project so there may be some duplication. Historically, duplication has been in the 3-4% data range.
  2. The numbers of Medicaid members impacted by each project

Variables impacting this measure over time include provider participation in payment reform initiatives, Medicaid member access to participating providers, and the development and implementation of new payment reform programs.

The trendline has held steady after a sharp increase in January 2020 and again in January 2022.  Attribution to the VMNG program is the biggest driver of results for this measure.  Attribution for that program occurs in January of each year; between extensive provider participation and the implementation of an innovative statewide expanded attribution initiative (see “Strategy” section below), impact may be close to the maximum achievable level. 

Narrative last updated:  06/15/2022

Strategy

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. Further expansion occurred in 2022. 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