Nearly two years after abandoning its plans to establish the nation's first single-payer health care system, Vermont is forging ahead with another health care initiative that is less ambitious but could still make it a shining star for health reform advocates.
The Green Mountain State will become the first in the nation to set up a statewide all-payer accountable care organization that is open to all payers, including Medicaid, Medicare and commercial insurers.
The goal of the system is to develop uniform payments for medical services, no matter who is paying. ACOs that join the system will be paid the same amount for medical services by Medicare, Medicaid and commercial plans.
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The amount providers are paid for services will be tied to patient outcomes and other quality measures. Commercial payers will be expected to keep annual spending growth to less than 3.5 percent. The state is also aiming to keep the rise in Medicare spending below the national average.
Although the system will be voluntary, the state has said its goal is for 70 percent of insured residents to be receiving care through an ACO by 2022.
The statewide system will be financed by nearly $10 million in federal startup funds that were approved by the Centers for Medicare and Medicaid Services. CMS has been pushing for Medicare providers to opt in to three ACO programs that it runs as a way to move away from the fee-for-service reimbursement system under which most providers still operate.
"CMS and Vermont aim for broad ACO participation throughout the state, across all the significant payers and the majority of the care delivery system, to make redesigning the entire care delivery system a rational business strategy for Vermont providers and payers," CMS said in a statement.
Vermont Gov. Peter Shumlin, who was forced to concede defeat in his earlier push for a single-payer system, predicted that the soon-to-be-implemented system would "transform the state's health care system so it is geared towards keeping people healthy, not making money."
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