Vermont One Step Closer to New Health Insurance System

By Kristin Frechette |

Published 10/26 2016 12:27PM

Updated 10/26 2016 12:28PM

Copyright 2016 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

On Wednesday the Green Mountain Care Board voted to sign the Vermont All-Payer Accountable Care Organization (ACO) Model Agreement between the State of Vermont and the Centers for Medicare and Medicaid Services. 

The All-Payer model is an agreement between the State of Vermont, Medicare, Medicaid, and private insurers, this agreement gives incentives to doctors who keep people healthy instead of just seeing them when they are sick. 

Providers will be a part of the model only if they choose to be, and you can still see your same doctor. 

“This is an important next step in provider-led health care reform. The Board is grateful for the strong public input from across the health care spectrum, including patients, health insurers, hospitals, health care providers, FQHCs, Designated Agencies, Home Health Agencies, and the Office of the Health Care Advocate. Now we can begin the important work of implementing the all-payer model with guidance and insight from providers who care for Vermonters every day,” said  Al Gobeille, Green Mountain Care Board Chair.

Vermont Governor Peter Shumlin will sign the agreement on Thursday, and sent the following statement: 

“Vermont will now become the first state in America to ensure that your doctor can focus on keeping you healthy, rather than running tests or procedures. By shifting the focus away from the current fee-for-service system to one that rewards primary care and prevention, we will help Vermonters lead healthier lives and more effectively manage chronic diseases, allow doctors to better treat their patients and identify health issues before they become severe, and reduce costs in a health care system that, if left unchecked, will bankrupt our state and Vermont families.

“Getting control of health care costs is the single biggest thing we can do to make Vermont a more affordable place to live, work, and raise a family. This agreement will allow us to begin controlling skyrocketing health care costs, bringing relief to Vermont families, employers, and the state budget.

“Since I came to office, we have worked to transform Vermont’s broken health care system so it begins working for Vermonters. By expanding access to health insurance to over 20,000 Vermonters, we have achieved virtual universal access to health care. And with this agreement, we will become the first state in America to fundamentally transform our entire health care system so it is geared towards keeping people healthy, not making money.   

“I want to thank President Obama, Secretary Burwell, and their teams for working with us to make this agreement a reality. I also want to thank the Green Mountain Care Board and its Chairman Al Gobeille, Vermont’s congressional delegation, and my health care team for their incredible work on behalf of Vermont.

“This agreement is historic, but it is only the first step. We have a lot of work to do to implement the agreement so it fulfills the promise of a health care system that works for all Vermonters. I look forward to continuing that hard work in the coming months.”   

Below you can find the key features of the agreement. 

  • Maintains and protects all Medicare beneficiary rights and protections, choice of providers, and includes the same services and coverage, at a minimum, as original Medicare. Likewise, commercial and Medicaid beneficiaries maintain all rights and protections, choice of providers, and covered services consistent with their coverage or plan.
  • Creates an opportunity for health care providers to participate in a common system of value-based payment, while maintaining full provider choice on whether to participate. Participating, eligible providers in Vermont may qualify for Advanced Alternative Payment Model bonus payments from CMS’ Quality Payment Program.
  • Establishes a 3.5% target rate of growth for all-payer per-capita health care expenditures, in keeping with Act 48 of 2011 and the GMCB’s charge to reduce the rate of growth in health care costs while maintaining or improving health care quality.
  • Highlights three goals for improving population health: 1) improving access to primary care, 2) reducing deaths from suicide and drug overdose and 3) reducing the prevalence and morbidity of chronic obstructive pulmonary disease, diabetes, and hypertension.
  • Preserves Medicare funding for Vermont’s nationally-recognized Blueprint for Health program serving people with complex health needs and Support and Services at Home (SASH) program for Medicare beneficiaries.







Copyright 2016 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.