*Due to the PHE and our alignment with federal provisions, the ACO earned a 100% quality score in CY2020.
This measure is important because it reflects the quality of care provided by the providers participating in the Vermont Medicaid Next Generation (VMNG) program for Accountable Care Organization (ACO) attributed Medicaid members.
The VMNG ACO program contract between DVHA and OneCare Vermont contains a quality framework with 13 measures related to preventive care, acute care, chronic disease care, and member experience. To the extent possible, quality measures included in the VMNG contract were selected to align with measures included in the Vermont All-Payer ACO Model agreement with the Centers for Medicare and Medicaid Services (CMS).
OneCare’s performance on ten of those measures impacts the amount of funds for quality performance incentives that can be earned by OneCare and its participating providers. Performance targets have become more rigorous over time, with high-level performance and continuous improvements in care as the goals. Performance improvement is challenging and complex, and is impacted by a number of variables, including population demographics and health behaviors, characteristics of new providers joining OneCare, availability of services, and OneCare’s ability to engage providers in quality improvement initiatives.
The trendline suggests that OneCare’s performance improved over time between 2017 and 2019. Beginning in early 2020 the COVID-19 Public Health Emergency (PHE) had a significant impact on the delivery of health care in Vermont, as elective visits and procedures were curtailed to reduce transmission of the virus. One of the many tragic consequences of the PHE is that important care had to be deferred. Consequently, health care providers’ quality results, which measure whether things like preventive visits have occurred, declined. The decision was made for 2020 to be a reporting year only, so OneCare’s score was 100%. This approach mirrored the approach taken by CMS.
OneCare’s quality score for 2021 was 68.8%. While the PHE impact on performance appears to have continued into 2021, it is important to note that OneCare’s quality results are fairly positive when compared to national results. OneCare’s performance exceeded the national 90th percentile for 4 measures, exceeded the national 75th percentile for 1 measure, exceeded the national 50th percentile for 4 measures, and was below the national 25th percentile for 1 measure.
Narrative last updated: 01/17/23
It will take time to fully understand the impact of the PHE on health outcomes. DVHA will continue to closely monitor results for these measures over time and as compared to national performance.