Vermont's all-payer model isn't meeting targets, needs revamp, CMS says


CMS sent a warning notice to Vermont last week calling for a reboot of its all-payer model, which hasn't met its participation or savings goals, according to the VT Digger.

Under Vermont's all-payer model, funds from Medicare, Medicaid and commercial insurers pay for services on a per-patient basis instead of fee-for-service. CMS found that for 2018 and 2019, the model was far from reaching its goals. More than half a million residents are supposed to be in the program in two more years, but the program is only 30 percent to goal with 160,000 participants.

The state's all-payer model also hasn't significantly increased primary care use or reduced spending increases, according to the notice, cited by the VT Digger.

Susan Barrett, director of the Green Mountain Care Board — which oversees the state's all-payer system — told the VT Digger that changes need to be made to the system to reach the goals. Adjustments include addressing barriers to entry for providers, as small hospitals have had to take on more financial risk under the model.

CMS gave Vermont 90 days to respond to its notice, which was sent Sept. 14. The federal government will create a corrective action plan if the state isn't able to provide a satisfactory response, according to the report. 

Read the full article here.

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