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Vermont State Innovation Model

Vermont State Innovation Model. Medicaid’s Proposed ACO Shared Savings Program Standards. Presentation to Vermont Council of Developmental and Mental Health Services August 23, 2013 Kara Suter, MS Director of Payment Reform, DVHA. Goals for Steering Committee.

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Vermont State Innovation Model

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  1. Vermont State Innovation Model Medicaid’s Proposed ACO Shared Savings Program Standards Presentation to Vermont Council of Developmental and Mental Health Services August 23, 2013 Kara Suter, MS Director of Payment Reform, DVHA

  2. Goals for Steering Committee

  3. Shared Savings ACO Programs, 1 of 3 Models to Test State Innovation Model Proposal http://gmcboard.vermont.gov/sites/gmcboard/files/Project%20Narrative.pdf

  4. Vermont State Innovation Model Shared Savings ACO Programs 101

  5. Vermont State Innovation Model Background and Definitions What is an aco shared savings program?

  6. What is an ACO Shared Savings Program (SSP)? A performance-based contract between a payer and provider organization that sets forth a value-based program to govern the determination of sharing of savings between the parties. http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2012/Aug/1618_Forster_accountable_care_strategies_premier.pdf

  7. What is an ACO? Accountable Care Organizations (ACOs) are comprised of and led by health care providers who have agreed to be accountable for the cost and quality of care for a defined population. These providers work together to manage and coordinate care for their patients and have established mechanisms for shared governance. *SIM Payment Standards Work Group Definition 2013 Xcenda Slide Presentation. 2012

  8. What Does this Mean for Beneficiaries? • The Program is designed to improve beneficiary outcomes and increase value of care by: • Promoting accountability for the care of beneficiaries • Requiring coordinated care for all services provided under FFS systems • Encouraging investment in infrastructure and redesigned care processes • The Program also would aim to reduce: • lost or unavailable medical charts • duplicated medical procedures • having to share the same information over and over with different doctors • ACOs are NOT HMOs • They do not affect beneficiaries access or choice in health care providers • There is no “gate keeper” • There is no change to beneficiary coverage benefits • They are governed by the same providers who provide care https://www.rmf.harvard.edu/Clinician-Resources/Article/2012/ACO-Explaining-the-benefits-of-it-to-Patients http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogram/

  9. Vermont State Innovation Model Attributing Patients & Calculating Savings How A program works

  10. Medicaid Patient Attribution ACO People see their PCP as they usually do If their PCP belongs to an ACO, the ACO accepts responsibility for the cost and quality of care provided to that person Providers bill FFS as they usually do

  11. Calculating Medicaid Shared Savings Risk Adjustment Projected Expenditures Actual Expenditures Shared Savings Quality Targets Matched Federal $$ Payer Accountable Care Organizations

  12. Vermont State Innovation Model Proposed Standards and process

  13. Process to Date: Standards

  14. Process to Date: Standards

  15. Process to Date: Performance Standards

  16. Process to Date: Performance Standards

  17. Process to Date: Performance Standards

  18. Process to Date: Care Model Standards

  19. Process to Date: Care Model Standards

  20. Presentation Focus

  21. Vermont State Innovation Model Key Milestones

  22. Proposed Timeline for Medicaid ACO SSP

  23. Vermont State Innovation Model Standards for discussion

  24. Vermont State Innovation Model Two track option

  25. Medicare “Two Track Option”

  26. Risk and Savings Percentages

  27. Vermont State Innovation Model Participation and governance Requirements

  28. Provider Participation Requirements

  29. Governance Requirements

  30. Participation and Governance Standards

  31. Vermont State Innovation Model Included/Excluded costs

  32. Total Cost of Care

  33. Inclusion/Exclusion of Costs

  34. Vermont State Innovation Model Attribution

  35. Attribution *While Blueprint requires PCPs to be NCQA certified, Medicaid proposes the SSP attribution would not contain this requirement in the first three years

  36. Attribution

  37. Attribution

  38. Inclusion/Exclusion of Costs

  39. Vermont State Innovation Model ENROLLMENT and Population exclusions

  40. Medicaid’s Proposed ACO SSP Six Enrollment Categories 1 2 3 4 5 6 Currently any member with other insurance (TPL, Medicare) would be excluded; Dual eligible would be revisited in year two should the financial alignment demonstration proceed

  41. Inclusion/Exclusion of Costs

  42. Vermont State Innovation Model Proposed Performance metrics (prior to aug 26 work group mtg)Refer to Measures Across Programs and Years handout

  43. Vermont State Innovation Model Overview

  44. Medicaid ACO SSP Development Update

  45. Medicaid ACO SSP Development Update

  46. Medicaid ACO SSP Development Update

  47. Vermont State Innovation Model Wrap up

  48. Discussion and Next Steps

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