Payment Reform Unit

# of Medicaid members per month for whom a prospective payment was made to OneCare Vermont from DVHA as part of the Vermont Medicaid Next Generation (VMNG) ACO program

99,501Oct 2020

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Notes on Methodology
       
  PMPM Payment Information by Medicaid Eligibility Group (MEG) by Month  
    CY 2020  
    Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20  
  % of 29,102 (2017)
% of 42,342 (2018)
% of 79,140 (2019)
% of 85,937 (2020)
95.8% 93.8% 92.7% 92.0% 92.7% 92.8% 92.7% 92.7% 92.6% 92.4%  
  Target # N/A 80,805 79,097 78,179 77,553 78,144 78,215 78,183 78,116 78,040  
  Total # 82,370 80,629 79,693 79,055 79,658 79,730 79,697 79,629 79,551 79,407  
  ABD # 5,683 5,599 5,530 5,504 5,493 5,458 5,439 5,414 5,390 5,361  
  ABD % 6.90% 6.9% 6.9% 7.0% 6.9% 6.8% 6.8% 6.8% 6.8% 6.8%  
  Non-ABD Adult # 4014 3,915 3,857 3,823 3,881 3,892 3,894 3,890 3,889 3,890  
  Non-ABD Adult % 4.9% 4.9% 4.8% 4.8% 4.9% 4.9% 4.9% 4.9% 4.9% 4.9%  
  New Adult # 29,335 28,502 27,895 27,491 27,771 27,774 27,734 27,671 27,598 27,508  
  New Adult % 35.6% 35.3% 35.0% 34.8% 34.9% 34.8% 34.8% 34.7% 34.7% 34.64%  
  Gen Child # 43338 42,613 42,411 42,237 42,513 42,606 42,630 42,654 42,674 42,648  
  Gen Child % 52.6% 52.9% 53.2% 53.4% 53.4% 53.4% 53.5% 53.6% 53.6% 53.7%  
  Expanded Attribution Cohort  
  % of 28,398 74.6% 71.9% 70.3% 69.4% 70.1% 70.4% 70.4% 70.6% 70.8% 70.8%  
  Target # N/A 20,776 20031 19590 19325 19533 19612 19,620 19680 19,737  
  Total # 21,178 20,419 19,969 19,699 19,911 19,992 20,000 20,061 20,119 20,094  
  ABD # 800 733 719 719 721 727 722 728 729 731  
  ABD % 3.8% 3.6% 3.6% 3.6% 3.6% 3.6% 3.6% 3.6% 3.6% 3.6%  
  Non-ABD Adult # 4,532 4,336 4,223 4,112 4,167 4,183 4,198 4,218 4,230 4,224  
  Non-ABD Adult % 21.4% 21.2% 21.1% 20.9% 20.9% 20.9% 21.0% 21.0% 21.0% 21.0%  
  New Adult # 10,334 9,955 9,713 9580 9676 9706 9691 9,689 9,713 9,703  
  New Adult % 48.8% 48.8% 48.6% 48.6% 48.6% 48.5% 48.5% 48.3% 48.3% 48.3%  
  Gen Child # 5,512 5,395 5,314 5288 5347 5376 5389 5,426 5,447 5,436  
  Gen Child % 26.0% 26.4% 26.6% 26.8% 26.9% 26.9% 26.9% 27.0% 27.1% 27.1%  
  Combined tradtional & expanded target #:     N/A 101,581 99,128 97,768 96,878 97,677 97,827 97,803 97,796 97,776  
  Combined tradtional & expanded total #: 103,548 101,048 99,662 98,754 99,569 99,722 99,697 99,690 99,670 99,501  
                         
                         
Partners
  • DXC Technology
  • OneCare Vermont
Story Behind the Curve

This measure shows ACO Attribution. It is broken down by Medicaid Eligibility Group (MEG) and shows what percentage of each MEG makes up the reported total.

This measure is a useful indicator of:

  • How many actively attributed members the ACO has in a given month (which helps quantify the program’s scale)
  • Any fluctuation in attribution on a month-to-month basis, overall and by MEG (which helps quantify population dynamism and the effects of changing Medicaid eligibility on prospective ACO attribution).

Member attribution to the VMNG ACO program is set prospectively (at the beginning of a performance year), and no new members are added to the population during a performance year. However, prospectively attributed members may be considered ineligible for attribution in a given month due to a number of factors, including eligibility changes (e.g. loss of Medicaid coverage); evidence of an additional source of insurance coverage or ageing into Medicare eligibility; death; or termination of a contractual relationship between an attributing provider practice and the ACO (at which time all members that had been attributed through that practice are no longer considered attributed to the ACO). Some members may subsequently become eligible for attribution again after losing eligibility in an earlier point in the year, but a 1-1.5% decrease in the number of PMPM payments made is expected month-to-month in a given program year. The more significant decrease (4%) in the number of members for whom payments were made between April and May highlights an instance in which an entire practice’s membership was removed from the ACO-attributed population due to termination of a contractual relationship between that practice and the ACO (OneCare Vermont).

Last updated:  10/21/2020

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy