In November, OneCare Vermont (OCV), an accountable care organization dedicated to improving Vermont’s healthcare system, announced it would close operations at the end of 2025.
This decision comes as the Vermont All-Payer ACO Model (VTAPM), a state-led initiative designed specifically for Vermont, will conclude at the end of calendar year 2025.
Vermont is one of the first states to participate in the All-Payer Health Equity Approaches and Development (AHEAD) Model, which will hold participating states accountable for monitoring overall health care spending growth and improving health outcomes. health of the population.
As Healthcare innovation As reported in December 2022, a major blow to OCV’s effort came just after the Center for Medicare and Medicaid Innovation released its second evaluation report on Vermont’s all-payer ACO model, when the organization nonprofit Blue Cross and Blue Shield of Vermont announced it would retire. of OCV for the 2023 plan year.
At the time, Blue Cross issued a statement saying that despite having collaborated with OCV every year since its inception, it was unable to reach an agreement that year “due to a lack of tangible quality results, an inability to bend the curve costs and the new approach to data that introduces security and privacy concerns.”
According to a 2022 news story on VTDigger, Blue Cross’ withdrawal “cuts the number of Vermonters enrolled in the OneCare portfolio by about 93,000 people, about a third of its total, and reduces the amount of health care spending under contract with the ACO. in the same percentage, according to estimates for 2023 from the Green Mountain Care Board.”
CMMI’s evaluation that year found that although the pandemic and a cyberattack on the University of Vermont Health System posed unique challenges in 2020, the Medicare ACO initiative continued to reduce spending and utilization in the third year of payment in relationship with a comparison group. The initiative also continued to see progress towards the goals of improving the population’s health.
OCV said the organization has also played a crucial role in stabilizing primary care through its population health programs and its Comprehensive Payment Reform (CPR) program for independent primary care practices.
In its final year of operation, OneCare said it is committed to supporting its network of participants to achieve quality and cost-sharing goals. The organization said it intends to maintain consistency for participants during the final year of the Vermont All-Payer model. All programs, investments and waivers will operate as previously planned to facilitate a smooth transition as participants explore future opportunities for 2026.
“Throughout a challenging reform environment, OneCare has successfully united providers across the spectrum of care to pursue common goals,” Anya Rader Wallack, chair of OneCare’s board of directors, said in a statement. “This effort built on a long history of successful health care reform programs in Vermont, and I am confident that the foundation we have laid will serve as a solid foundation for future innovations. On behalf of the board I want to thank the resourceful team at OneCare for their dedication to this important work.”
Under the AHEAD model, CMS will issue agreements to each participating state, which could receive up to $12 million from CMS during the first five and a half years of the model to support implementation.
The AHEAD model is planned to operate for a total of 11 years, from 2024 to 2034.
Under a total cost of care approach, a participating state uses its authority to assume responsibility for managing the quality and costs of health care across all payers, including Medicare, Medicaid, and private coverage. States also take responsibility for ensuring that their state’s health care providers provide high-quality care, improve population health, offer greater coordination of care, and promote health equity by supporting underserved patients.
The AHEAD model will provide participating states with funding and other tools to address rising health care costs and support health equity. But the model also holds states accountable for specific Medicare and primary care investment and cost growth goals for all payers, and for population health outcomes and health equity.
Vermont sees the AHEAD model as a way to collaborate with the federal government to impact the way Medicare, the insurer for 21 percent of Vermonters, pays hospitals, supports primary care, improves health equity and allows flexibility in the way care is delivered.
