Payment Reform Unit

# of Medicaid members who are impacted by payment reform projects

121,368Jul 2020

Line Bar
Notes on Methodology

The target for this measure is 110,000 unduplicated Medicaid members

 

Partners
  • OneCare Vermont ACO and many providers
  • Green Mountain Care Board
  • Department of Mental Health
  • Vermont Department of Health (Division of Alcohol and Drug Abuse Programs)
  • DVHA Quality Improvement and Clinical Integrity Unit
Story Behind the Curve

The DVHA Payment Reform Unit is engaged in a number of projects designed to address the triple aim of reducing growth in health care costs, improving care, and improving the health of the population. Projects include the Vermont Medicaid Next Generation ACO program (featuring all-inclusive population based payments), the Department of Mental Health project (a case rate model), the Residential Substance Use Disorder project (episodic payments), and the Applied Behavior Analysis (autism benefit) project (prospective monthly bundled payments).

The data presents two views of the information: an unduplicated count of Medicaid members impacted by payment reform (members may be impacted by more than one project), and the numbers of Medicaid members impacted by each project. Variables impacting this measure over time include provider participation in payment reform initiatives, Medicaid member access to participating providers, and the development and implementation of new payment reform programs.

Four of the mental health designated agencies (DAs) made a EHR switch last fall and data for those DAs is incomplete for Nov 2019.  This impacted the duplicated and unduplicated totals in the trend line and table above.

Last updated 10/15/2020

Strategy

In addition to collaborating with OneCare Vermont, the Green Mountain Care Board, and various providers to increase scale in the Vermont Medicaid Next Generation program, the Payment Reform Unit is working to design and implement additional payment reform projects, including the Developmental Disability Services project and the Children’s Integrated Services project.

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