2019 Results for Shared Savings by Payer Program
Medicare
Participating providers earned a total of $11.3 million in Medicare shared savings from collaborative work to improve beneficiaries’ outcomes and overall health of the Medicare population.
Of the $11.3 million, OneCare paid $8 million of advanced shared savings throughout 2019 to fund the Patient Centered Medical Home, Community Health Team, and SASH population health management payments.
The remaining $3.3 million will be distributed directly to risk-bearing providers that participate in OneCare’s Medicare program and reinvested in additional programs, services and initiatives to further improve health and reduce costs.
Medicaid
OneCare Vermont went over the budget target for Medicaid and the year-end reconciling payment represents providers accepting accountability for cost and quality of care.
OneCare paid Department of Vermont Health Access $6.7 million for the 2019 performance year.
BlueCross BlueShield of Vermont
For 2019, OneCare participated in the BCBSVT program as upside risk only. The ACO did not receive shared savings or losses.
Combined Shared Savings and Losses for Performance Year 2019
| Medicare | ||
|---|---|---|
| Settlement Payment* | $11,059,786 | |
| % of TCOC | 2.2% | |
| Fixed Payment Performance | $0 | |
| Combined Result** | $11,059,786 | |
| Medicaid | ||
|---|---|---|
| Settlement Payment* | ($6,505,293) | |
| % of TCOC | (3.2%) | |
| Fixed Payment Performance | $8,245,865 | |
| Combined Result | $1,740,572 | |
| BlueCross BlueShield of Vermont | ||
|---|---|---|
| Settlement Payment* | $0 | |
| % of TCOC | 0% | |
| Fixed Payment Performance | $0 | |
| Combined Result*** | $0 | |
* Settlement payment amounts incorporate any applicable risk corridor constraints and/or sharing factors per contract terms.
** OneCare was paid $8,021,268 of advanced shared savings throughout 2019. These dollars supplied OneCare with the cash flow for the Patient Centered Medical Home, Community Health Team, and SASH population health management payments. 100% of Shared Savings were distributed to Initiative Participants and Preferred Providers.
*** While no settlement payment was owed to BCBSVT, OneCare was required to reinvest $10k in its network as a result of program performance.