The Payment Reform Unit seeks to transition Vermont Medicaid’s health care revenue model from Fee-for-Service payments to value-based payments with the goal of providing better, more efficient, coordinated care for Vermonters. In support of this goal, the Payment Reform Unit partners with internal and external stakeholders in taking incremental steps toward the integrated healthcare system envisioned by the Vermont All-Payer Accountable Care Organization Model agreement with the Centers for Medicare and Medicaid Services. The Payment Reform Unit also works with providers and provider organizations in testing models, and ensures the models encourage higher quality of care and are supported by robust monitoring and evaluation plans.

The Payment Reform Unit is available as a resource to DVHA and to other departments within the Agency of Human Services in the consideration of potential payment reform options. The unit is also responsible for the implementation and oversight of the Vermont Medicaid Next Generation (VMNG) Accountable Care Organization (ACO) program, a financial model designed to support and empower the clinical and operational capabilities of the ACO provider network in support of the Triple Aim of better care, better health and lower costs.

By designing and testing new payment models both for DVHA and other departments within the Agency of Human Services, the Payment Reform unit plays a crucial role in support of DVHA’s goal of transitioning to more value-based payment structures which in turn supports Vermont’s overall health reform efforts. All models being developed ultimately support the Triple Aim in healthcare, which will ensure better care, better health, and lower costs for Vermonters.

SFY24 priorities are:

• Continue to oversee the implementation, evaluation, and evolution of the Vermont Medicaid Next Generation (VMNG) program, including successful negotiation of 2024 VMNG contract amendment (including the Global Payment Program, (pending federal approval) and planning for the next stage of the program, and future alignment with the next iteration of the All-Payer Model Agreement.
• We anticipate engaging in a new payment reform project with the Division of Substance Use with a target implementation date of 1/1/2026.
• Finalize VBP design for DS payment reform by the end of SF2024.
• Incorporate best practices for payment reform design, implementation, and evaluation into new and existing payment reform projects.