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Evaluation of the Vermont All-Payer Accountable Care Organization Model

Peak autumn foliage near rural Waits River in Vermont
Evaluating Vermont’s efforts to improve health outcomes and reduce health care spending
  • Client
    Center for Medicare & Medicaid Innovation within the Centers for Medicare & Medicaid Services
  • Dates
    2018 - 2024

Problem

Policymakers wanted to know whether an alternative payment model has improved health care and cut costs for Vermonters. 

In its continuing investigation of innovative ways to improve care for millions of enrollees while lowering spending, the Centers for Medicare & Medicaid Services (CMS) sought to examine the Vermont All-Payer Accountable Care Organization (ACO) Model. This model was designed to test whether scaling an ACO model across Medicare, Medicaid, and commercial payers would support broad care delivery transformation, lower health care spending, and improve health outcomes for Vermonters. As part of the model requirements, Vermont is accountable for meeting statewide participation, financial, and population health targets.

Solution

NORC is using a mixed-methods approach to understand the impact of the Vermont  model.  

The CMS Center for Medicare & Medicaid Innovation tasked NORC at the University of Chicago with conducting an independent evaluation of the Vermont All-Payer ACO Model to assess its implementation and impact. Because the model builds on nearly two decades of health reform initiatives in Vermont—and incorporates pre-existing care delivery transformation initiatives, including the Blueprint for Health—evaluating its impact was challenging from the onset. To understand the model’s implementation, impact, key drivers, and lessons learned for future reform efforts in other states, NORC’s evaluation approach includes:

NORC’s mixed-method approach integrates:

  • Quantitative analyses of Vermont Medicare claims to assess performance on spending, utilization, and quality outcomes relative to a comparison group of 26 other states.
  • Qualitative analyses of information collected through document review and dozens of semi-structured interviews with state officials, ACO leaders, commercial payers, hospital leaders, physicians, mental health providers, home health care providers, trade association leaders, community organizations, and others involved in model implementation.
  • A survey of Vermont clinicians’ perceptions of the model and Vermont’s health reform efforts.

In 2020, the COVID-19 public health emergency (PHE) drastically changed the health care landscape in Vermont and nationwide, further complicating the evaluation of this model. NORC adapted the evaluation approach in response, including pivoting to virtual data collection and quantitatively accounting for differences in COVID-19 PHE burden between Vermont and comparison states.

Result

Our evaluation has shown that the model was associated with reductions in Medicare spending. The state also has made improvements in population health and quality outcomes.  

Despite the disruption of the COVID-19 PHE, Vermont has shown spending decreases for Medicare beneficiaries and continued to make progress towards targets for population-level health outcomes and quality metrics. While such progress is likely due in part to the model’s increased investment in population health initiatives, it may also reflect the continuation of investments in primary care and population health transformation that predated and have continued throughout the model’s performance period. Despite challenges that have limited participation, the model so far shows promising results.

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Departments, Centers & Programs

Research Divisions

Project Leads

“Results from the model’s first three years are promising and may continue to increase over time. While our evaluation identified challenges in the implementation of the model, we also found that it has served as a catalyst for increasing collaboration between hospitals and community organizations and increasing investments in population health.”

Vermont All-Payer Project Director

“Results from the model’s first three years are promising and may continue to increase over time. While our evaluation identified challenges in the implementation of the model, we also found that it has served as a catalyst for increasing collaboration between hospitals and community organizations and increasing investments in population health.”

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