Vermont's Value-Based Health Care System Shows Progress

Good news alert! I feel the need to open with that announcement given the barrage of challenges we face in health care and the unending pandemic twists and turns we continue to manage. Good news in health care can easily be dwarfed by stories of heartache and sorrow, yet if you simply look around, there are hopeful signs all around us.
Last week, a positive and optimistic story emerged regarding our state’s health reform initiative. The headline is that in 2018 and 2019, Vermont made measurable and meaningful progress toward a value-based health care system where the primary focus is on prevention, care management and coordination around each patient.
The report recognizing Vermont’s progress was from the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees the implementation of our state’s All Payer Model (APM) reform plan.
According to CMS, the APM achieved statistically significant Medicare gross spending
reductions at both the ACO (that’s OneCare Vermont) and state levels. It also showed Medicare net spending reductions at the state level. Additionally, there were statistically significant declines in acute care stays (at both the ACO and state levels) and in 30-day readmissions.
In plain English, there were savings from our work and declines in unnecessary or avoidable hospital stays, which we know lead to better health outcomes. While the model’s mechanics are incredibly complex, the concept is quite simple. In the most basic terms, we are bringing together providers to care for the whole person, giving doctors data and support to promote best practices, create greater collaboration with the patient and focus more on wellness and disease management than tests and procedures.
These results are profound. Not because we’ve realized the vision of value-based care or
population health, but because it shows that as far back as 2018 (which feels like a lifetime ago at this point), we were on the right track. There is no question COVID-19 has disrupted our work, but there’s also no question we are in a better place as a result of the APM and OneCare as we continue to weather the pandemic.
It’s easy to find criticism of health care reform work in Vermont—some fair and some not. Chief among the complaints is the pace at which change is realized. Well, have you or someone you know ever tried to lose weight, control blood pressure or manage chronic depression? If you have, you know that this work takes time—a lot of time—and, often it’s a life-long, decades-long journey.
It stands to reason that this health reform journey and the true change we seek will not happen during the five-year APM waiver we’re about to conclude or during an extension or even a next generation waiver. It will happen over time as we work with providers, state leaders and Vermonters themselves.
We are as committed to this work now as we ever were. CMS has given us compelling proof points that we are on the right track. With continued team work and commitment, we will both improve the lives of Vermonters and bend health care’s cost curve.
Here’s to some good news. Let’s be on the lookout for more!