Vermont Global Commitment to Health Demonstration Evaluation

Problem

CMS requires Vermont to monitor progress toward Demonstration goals.

Since 2005, Vermont has used the Global Commitment to Health Demonstration (“Demonstration”) to implement large-scale Medicaid transformation and payment reform. The current Demonstration focuses on services to address substance use disorder (SUD), serious mental illness (SMI), and serious emotional disturbance (SED).

The Centers for Medicare & Medicaid Services (CMS) extended Vermont’s 1115 Waiver from July 2022 through December 2027. Vermont identified the following Demonstration goals:

Advance the state toward population-wide comprehensive coverage
Implement innovative care models across the continuum that produce value
Engage Vermonters in transforming their health
Strengthen care coordination and population health management capabilities to encompass the full spectrum of health-related services and supports
Accelerate payment reform

In the extension period, Vermont will continue to focus on improving equity, coverage, and access for Medicaid beneficiaries and low-income by strengthening its Demonstration programs. AHS also obtained federal Medicaid matching funds for 66 programs focused on public health, health care, and health-related investments in Vermont.

Solution

NORC is using primary and secondary data to understand the demonstration’s impact.

NORC is leading a mixed-methods evaluation to capture insights about the implementation process and overall impact of the Demonstration and associated investments. This approach uses primary and secondary data to describe trends in utilization, quality and cost and how the Demonstration has transformed care for Vermonters with Medicaid coverage over the five-year period.

The SUD and SMI mid-point assessments examine progress, capacity, access, and challenges achieving service milestones. Data sources include document review, claims-based metrics, key informant interviews, and provider surveys.

Additionally, in partnership with John Snow Research and Training Institute, Inc. (JSI), we are conducting brief assessments of related programs focused on public health, health care, and health-related investments for Medicaid members.

Result

Our findings will inform Vermont’s ongoing health reform efforts.

The evaluation design began in 2023 and will continue through December 2029. We will conduct mid-point assessments for Demonstration services focused on Medicaid members with SMI/SED (June 2024) and SUD (June 2025). We will also develop interim and summative evaluation reports for CMS in 2026 and 2029. Throughout the contract period, we will also collaborate with AHS and relevant state agencies to design and produce brief assessments of the innovative investments. Findings will inform progress on Demonstration milestones, future Demonstration investments, and health reform efforts in Vermont.