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Center for Medicare and Medicaid Services' Report Recognizes Vermont's All-Payer Health Reform

April 9, 2019

Montpelier, Vt. – Monday, RTI International – a non-profit research institution – published its final impact analysis for the Centers for Medicare and Medicaid Services’ (CMS) State Innovation Model (SIM) Round 1 awardees.

Of the nine alternative payment and delivery models tested, only Vermont’s Accountable Care Organization (ACO) model yielded relative Medicaid savings - $97 million across the three implementation years. In addition, Vermont’s ACO program had significant reductions in emergency department visits and inpatient admissions to the hospital.

“The report’s findings are incredibly encouraging and demonstrate the merit of our approach. I appreciate the hard work - spanning multiple Administrations - to distinguish Vermont’s health care reform efforts,” said Governor Phil Scott. “Being innovative in our work to limit growth in health care costs is crucial to long-term affordability, and I’m pleased Vermont is leading on this effort.”

Vermont’s significant achievements, as outlined by CMS, are a solid platform for providers to assume downside risk in today’s All-Payer ACO Model. The findings demonstrate the positive impact that a coalition of willing heath care providers can have on the health care system, especially when leveraging previous reform efforts such as the Blueprint for Health Patient Centered Medical Home infrastructure.

The report concludes, “Although still in its early implementation phase, Vermont’s All-Payer ACO Model, which was developed under and informed by the SIM Initiative, is expected to continue the momentum of payment and delivery model reform across the state.”

CMS notes that Vermont was the only state to create an aligned model across all participating payers, likely contributing to its strong results. With similar program rules for Medicaid, commercial payers and Medicare, providers can focus more effort and attention on their goals for quality improvement, rather than on competing sets of rules. Vermont has strongly maintained this principle in its current All-Payer Model Agreement, knowing that it is a foundation for innovation and improvement.

Secretary of the Agency of Human Services Al Gobeille said, "This is concrete evidence that heath care reform can work. By working together and aligning our efforts, we can save money and improve the patient experience."

The full report can be found at and a summary can be found at

About Vermont’s ACO and SIM Efforts

Vermont focused its SIM efforts on payment and delivery models, practice transformation, and health data infrastructure—including launch of an all-payer accountable care organization (ACO) Shared Savings Programs (SSP). By the end of the test period, the state entered an ACO-based model for payment and delivery system reform, the Vermont All-Payer ACO Model, which launched in January 2017 with the Vermont Medicaid Next Generation ACO model in four communities.

The Vermont ACO model is the Centers for Medicare & Medicaid Services’ (CMS) test of an alternative payment model in which the most significant payers throughout the entire state – Medicare, Medicaid, and commercial health care payers – incentivize health care value and quality, with a focus on health outcomes.