- Vermont Gov. Peter Shumlin (D) announced last week the state had received preliminary federal approval to implement an all-payer healthcare system that would be the first of its kind.
- Under the proposed system, the state's providers would work under a pay-for-performance model by joining a single accountable care organization for accepting payments from Medicare, Medicaid and private payers.
- Much is still up in the air, with the state planning three public forums for discussion of the new model draft, and the provision that the state's next administration will have that option of backing out.
The draft agreement was reached under the Affordable Care Act's Center for Medicare and Medicaid Innovation, which provides flexibility for states experimenting with new healthcare models.
Vermont's proposal raises the example of Maryland, which has been pioneering a form of an all-payer system since the 1970s and implemented an updated version in 2014 to include goals around healthcare quality to comply with the ACA. Under that five-year agreement, Maryland and CMS are testing whether the state can meet pre-set requirements around cost and quality, with preliminary results reported to be promising.
However, Vermont's proposed model would be somewhat unique in using the pay-for-performance model, the National Conference of State Legislatures told Vermont Public Radio. It would have government and private payers paying physicians monthly fees for patient care rather than paying them per service.
If the model is implemented, its goal will be to ensure that certain healthcare costs increase no more than 3.5% per year for five years, beginning in 2018.
While the model would also aim to establish a state-wide, integrated healthcare system, it only proposes encompassing about 30% of primary care providers in the state by 2018, and increasing that to 80% over five years.