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 (CMS).
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. Beginning in January 2023, the data shows a combined count of members who are attributed to the ACO through the traditional attribution methodology (where members demonstrate past utilization with a primary care provider [PCP] in the program) and 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). The program is a public-private partnership between DVHA, OneCare Vermont, and OneCare’s participating providers. Effective program design and implementation help determine participation by providers and attribution of Medicaid members.
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 aging 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 per member per month (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: 04/07/23
In order to meet its obligation under the State’s All-Payer ACO Model Agreement with 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 PCPs 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. Implementation of expanded attribution during the past three years has been successful and is continuing into 2023.