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Vermont all-payer ACO model approved, will count for MACRA

Under model, rates paid to a given provider are set so that all third parties pay the same price for services to particular provider.

Susan Morse, Senior Editor

The Centers for Medicare and Medicaid Services on Wednesday approved a new all-payer accountable care model for the state of Vermont.

The new ACO model will also allow physicians in the state to qualify for bonuses under MACRA's advanced alternative payment model track.

"This model may also allow eligible physicians and other clinicians in Vermont to qualify for Advanced Alternative Payment Model bonus payments from the Quality Payment Program given their commitment to be accountable and improve care for patients," said Patrick Conway, principal deputy administrator and chief medical officer for CMS.

Under the all-payer model, rates paid to a given provider are set so that all third parties, from Medicare, Medicaid and commercial insurers, pay the same price for services to that particular provider. This does not mean that all hospitals are paid the same.

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The model offers ACOs in Vermont the opportunity to participate in a Medicare ACO initiative tailored to the state. CMS is providing $9.5 million in start-up funding to assist medical providers with care coordination and to bolster their collaboration with community-based providers.

CMS is also encouraging Medicaid ACOs, as the agency has also approved a five-year extension of Vermont's Medicaid demonstration, which puts government program into the all-payer ACO model.

CMS and Vermont need broad ACO participation to make the redesign of the entire care delivery system a rational business strategy, CMS said.

CMS has been partnering with Maryland for the past three years as part of that state's all-payer model to reward value over volume.

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The Vermont all-payer model builds on the Maryland all-payer model by expanding statewide healthcare transformation beyond the hospital, CMS said.

Vermont's model is projected to provide insight for other state-driven all-payer payment and care delivery transformation efforts, CMS said.

CMS seeks public input on additional opportunities to partner with states on payment and care delivery reform to help meet its goal of tying 50 percent of Medicare payments to alternative payment models by 2018. 

Twitter: @SusanJMorse