Governor Phil Scott Announces Next Generation Medicaid Pilot Program

08 February 2017

Montpelier, Vt. – Today, Governor Phil Scott and Human Services Secretary Al Gobeille, joined by several doctors and health care providers, detailed the State’s Medicaid agreement with OneCare Vermont, representing a coalition of hospitals, independent practices, and other health providers. This initiative pilots an Accountable Care Organization (ACO) financial model, designed to provide better care, better health and lower costs for Vermonters and the State. 

“In our efforts to make health care more affordable and accessible, my Administration is focused on reforms that address costs, while putting the patient first and helping providers improve outcomes,” said Gov. Scott. “With this pilot program, we have the opportunity for objective evaluation to ensure these innovations are working towards these goals and improving the health of our most vulnerable.”

Last year, the State put out a request for proposals to accountable care organizations to pilot a per member per month reimbursement model for Medicaid. As a result, OneCare – with participation from four area hospitals as well as Federally Qualified Health Centers (FQHCs), independent practices, home health providers and Designated Agencies – will contract with the Department of Vermont Health Access (DVHA) to provide an array of services to Medicaid beneficiaries on a prospective payment schedule.

Under this pilot program, the State will pay a monthly fixed amount to the ACO for participating hospitals and providers. This model will support and empower the ACO provider network with more flexibility to deliver care based on what the health professionals believe will be most effective in promoting and managing the health of their patients. Currently, the State operates under a fee-for-service model, paying a fee after a bill is received for each service performed by a health care provider. This model will continue for all other non-hospital providers in the ACO.

“By moving to a system that pays for quality care and improved outcomes, rather than for services rendered, providers will be able to dedicate more time and energy to patients through a consistent and predictable Medicaid reimbursement schedule,” said Secretary Gobeille. “We believe by aligning the incentives in health care with outcomes, we can support a system that is both more affordable and provides better care.”

The agreement between DVHA and OneCare is for nearly 30,000 attributed Medicaid patients and nearly 2,000 unique health care providers. The pilot will run for one full year, with the total cost estimated to be $93 million in state and federally-matched funds. 

Contact Information

Office of Governor Phil Scott
109 State Street, Pavilion
Montpelier, VT 05609
Phone: 802 828-3333 (TTY: 800 649-6825)
Fax: 802 828-3339

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