Vermont receives preliminary federal approval for all payer model

The federal government and Vermont drafted an agreement to implement an all payer healthcare payment system following roughly two years of negotiations, VTDigger reports.

Here are eight things to know about the preliminary approval.

1. At a two-hour news conference Wednesday hosted by Gov. Peter Shumlin (D-Vt.) and Green Mountain Care Board Chair Al Gobeille, officials said they may sign the draft agreement within the next three weeks. The Green Mountain Care Board is in charge of lowering Vermont's healthcare cost while maintaining quality care.

2. The announcement comes three weeks after Gov. Shumlin met with HHS Secretary Sylvia Burwell to negotiate the payment transition. 

3. Under the all payer model, physician payments from commercial insurers, Medicare and Medicaid would be based on monthly fees instead of a fee-for-service model. Physicians would operate under an accountable care organization — either OneCare Vermont or Vermont Care Organization — which would accept the payments. The ACO would then pay physicians based on quality of care.

4. Vermont would become the first state to implement an all payer system for all providers. Maryland currently operates the only U.S. all payer system for just hospital services.

5. Under the model, Vermont officials want to keep some costs paid by Medicare, Medicaid and commercial insurance from growing more than 3.5 percent per year for five years, beginning in 2018.

6. The state aims to have about 30 percent of primary care providers under the model by Jan. 1, 2018, with 80 percent under the model over a five-year period. If Vermont's OneCare ACO decides to join the all payer model, the state would reach the initial 30 percent goal, Mr. Gobeille said. 

7. The Green Mountain Care Board would regulate the ACO. It currently approves hospital budgets and payer prices, according to the report. Gov. Shumlin said the all payer model could save Vermont about $10 billion over a 10-year period. 

8. The board will hold three meetings over the next three weeks to take public comment, according to the article.  

More articles about payer issues:
20 insurance startups join innovation hub
Independence Blue Cross extends coverage to MDxHealth prostate cancer test
BCBS of Nebraska to cover minimally invasive joint fusion

Copyright © 2022 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Podcast

Featured Webinars

Featured Whitepapers

Top 40 articles from the past 6 months