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), the High-Technology Nursing Services project (a monthly payment and FFS payments), 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 included in payment reform. Members may be included in more than one project so there may be some duplication. Historically, duplication has been in the 3-4% range.  
2. The numbers of Medicaid members included in 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 is set in January of each year; between extensive provider participation and the implementation of an innovative statewide expanded attribution methodology (see “Strategy” section below), attribution to the VMNG program may be close to the maximum achievable level. 

Narrative last updated:  01/17/23

• OneCare Vermont Accountable Care Organization (ACO) and many providers
• Green Mountain Care Board (GMCB)
• Department of Mental Health (DMH)
• Vermont Department of Health (VDH)
• Department of Children and Families (DCF)
• Department of Disabilities, Aging and Independent Living (DAIL)
• Department of Vermont Health Access (DVHA) Quality Improvement Unit (QIU) and Clinical Integrity Unit (CIU)

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 methodology.  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 (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.