21 Jun Lessons From Vermont’s So-Far Successful All-Payer Accountable Program

In 2014, Vermont took on a healthcare challenge of lowering spending and improving health results. All while trying to work within the boundaries of the existing payment system. The idea appealed to OneCare Vermont, an organization which specializes in connecting payers, providers and community organizations. The state’s largest payers, Medicare, Medicaid and Blue Cross and Blue Shields of Vermont were on board and agreed to provide financial resources to coordinate OneCare’s care system for high-medical risk individuals. In return, these three payers would increase enrollment over time.

It was not a small mountain to climb to unite physical, mental health, and social services while aligning existing facilities and services and bringing them closer together. Here are the anchors of this bold endeavor. 

1. Care Coordinators

Instead of starting from scratch and hiring new employees and setting up new departments, OneCare offered funds and resources to already existing employees at partner organizations. Now the case managers, nurses, social workers, counselors and other community health team members are not only able to help patients to manage their medical conditions but also more quickly assist with their social, financial, and psychological challenges.

2. Shared Care Plan

The goal of the Care Coordinator is to create a shared care plan and coordinate the effort. They concentrate on the outcome as opposed to a diagnosis. For example, telling the patient that he/she is prediabetic is what the doctor does, the Care Coordinator may help the patient with healthier eating habits and regular exercise schedule. Once the plan is created, it is accessible to all members of the team.

3. Effective Communication

Care Coordinators work using a Care Navigator software platform that allows a better way to communicate than phones or fax machines. Care Navigator does not replace electronic medical records; it highlights who is working with whom, creates a system of reminders about medical events, and generally promotes collaboration.

4. Patient Resources

Within the Care Navigator portal, the patient can keep track of assessments and goals as well as have access to a library of educational resources.

5. Data and Analytics

Sharing best practices and promoting standardization is key to ongoing progress and success of the All-Payer system. Access to shared data and analytics which enables performance tracking and care coordination will allow healthcare organization to focus on improving care while lowering the costs.

Results: (from The Commonwealth Fund)

Preliminary data suggest that OneCare is making progress in achieving the state’s population health goals. They show that Medicaid beneficiaries attributed to the ACO are making greater use of primary care and behavioral health services, as well as pharmacy benefits, compared with other beneficiaries.

How is it financed? (from The Commonwealth Fund)

Sunlit Cove Healthcare Consultants

We provide management and consulting services to help healthcare businesses run efficiently. Navigating the dynamic and complex revenue cycle management is a challenge for many health plans, health care vendors, and providers. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management. We manage all aspects of your enterprise from the development of the revenue cycle management process to the completion of your business cycle.

Related: Revenue Cycle Interim Management