Ver­mont gets pre­lim­i­nary OK to move to­ward all-payer sys­tem

Modern Healthcare - - REGIONAL NEWS - —Vir­gil Dick­son

Ver­mont has re­ceived ten­ta­tive ap­proval from the Obama ad­min­is­tra­tion to es­tab­lish an all-payer re­im­burse­ment sys­tem for health­care providers in the state start­ing in Jan­uary.

Mary­land has long had an all-payer sys­tem, but it cov­ers only hospi­tals. Ver­mont plans to use an ac­count­able care or­ga­ni­za­tion-type struc­ture that would cover all providers. All-payer sys­tems re­quire all in­sur­ers, whether pri­vate or gov­ern­men­tal, to pay sim­i­lar rates for ser­vices.

Ver­mont says its goal is to pro­vide higher-qual­ity care and re­duce cost growth. “I’m in­cred­i­bly op­ti­mistic that we can move to (an) out­comes­based pay­ment sys­tem with co­op­er­a­tion from the fed­eral gov­ern­ment that will al­low us to con­tain costs and to put money in Ver­mon­ters’ pock­ets,” Ver­mont’s Demo­cratic Gov. Peter Shum­lin said.

The ap­proval of Ver­mont’s Sec­tion 1115 waiver re­quest comes nearly three weeks af­ter Shum­lin trav­eled to Wash­ing­ton to ne­go­ti­ate a deal with HHS Sec­re­tary Sylvia Mathews Bur­well.

Un­der the pro­posal, mod­eled on Medi­care ACOs, providers would be paid global rates de­ter­mined by pa­tient pop­u­la­tions and health out­comes. Fee-for-ser­vice pay­ments would be scrapped. Some ex­perts say more states should consider such a sys­tem to speed the shift to value-based pay­ment.

Ver­mont’s demon­stra­tion waiver is be­ing reviewed by HHS and the state, ac­cord­ing to Robin Lunge, Ver­mont’s direc­tor of health­care re­form. If fi­nal­ized, the five-year demo would be­gin Jan. 1, 2017, and end Dec. 31, 2021.

Gov. Peter Shum­lin

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