Payment Reform Unit

What We Do

The Payment Reform Unit seeks to transition Vermont Medicaid’s health care revenue model from Fee-for-Service payments to value-based payments with the goal of providing better, more efficient, coordinated care for Vermonters. In support of this goal, the Payment Reform Unit partners with internal and external stakeholders in taking incremental steps toward the integrated healthcare system envisioned by the Vermont All-Payer Accountable Care Organization Model agreement with the Centers for Medicare and Medicaid Services. The Payment Reform Unit also works with providers and provider organizations in testing models, and ensures the models encourage higher quality of care and are supported by robust monitoring and evaluation plans.

Who We Serve

The Payment Reform Unit is available as a resource to DVHA and to other departments within the Agency of Human Services in the consideration of potential payment reform options. The unit is also responsible for the implementation and oversight of the Vermont Medicaid Next Generation (VMNG) Accountable Care Organization (ACO) program, a financial model designed to support and empower the clinical and operational capabilities of the ACO provider network in support of the Triple Aim of better care, better health and lower costs.

How We Impact

By designing and testing new payment models both for DVHA and other departments within the Agency of Human Services, the Payment Reform unit plays a crucial role in support of DVHA’s goal of transitioning to more value-based payment structures which in turn supports Vermont’s overall health reform efforts. All models being developed ultimately support the Triple Aim in healthcare, which will ensure better care, better health, and lower costs for Vermonters.

Action Plan

THE TOP PRIORITIES/INITIATIVES IN SFY20 are:

  • To continue to oversee the implementation, evaluation, and evolution of the Vermont Medicaid Next Generation (VMNG) program, as well as the Mental Health, Residential Substance Use Disorder, and Applied Behavior Analysis payment reform initiatives.
  • To provide support to Departmental and Agency leadership in considering and planning for any additional value-based payment reform models to support continued advancement toward an integrated healthcare system in Vermont.
  • To understand and engage in the unique internal and external stakeholder landscape for each Payment Reform initiative, emphasizing respectful, transparent, and collaborative interactions.

 

 

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