This measure is important because the DVHA Payment Reform Unit supports the CMS goal to accelerate the percentage of US health care payments tied to quality and value through the adoption of two-sided risk alternative payment models. These are: 

1.    Models built on fee for service (FFS) architecture with shared savings and downside risk (category 3 in the snip above; currently Vermont has no category 3 models).
2.    Models which involve prospective, population-based payments, structured in a manner that encourages providers to deliver well-coordinated, high-quality person-centered care within either a defined scope of practice, a comprehensive collection of care, or a highly integrated finance and delivery system (category 4 in the snip above; currently Vermont has two subcategories of category 4 models: condition-specific population-based payment and comprehensive population-based payment).

CMS has set a target of 50% of healthcare payments in alternative payment arrangements by 2030. Vermont has already surpassed this goal, hitting 68.6% of funding being provided through population-based payments in CY21.  DVHA will continue to move away from fee for service (FFS) and towards models tied to quality and value through the adoption of two-sided risk alternative payment models. The scorecard reflects the advancement made by Vermont Medicaid to achieve these goals.

The trending shows a decrease in FFS health care spending and increase in population- based payments, driven primarily by the Vermont Medicaid Next Generation ACO program. A small decrease in the percentage of ACO spending from 2020 to 2021 resulted in a minor percentage decrease (1.4%) in total category 4 spending in 2021 as compared to 2020. 

Narrative last updated: 09/12/23

• Blueprint
• DVHA Business Office
• Catalyst for Payment Reform
• Centers for Medicaid & Medicare Services (CMS)
• Healthcare Performance Learning & Action Network (HCPLAN)