Results
News and Updates:
OneCare Program Evaluation
Evaluation Brief and Executive Summary
OneCare contracted with Cynosure Health and its subcontractor, Westat Insight, to conduct a mixed methods evaluation of OneCare’s Community Complex Care Coordination, Value-Based Incentive Fund, and Comprehensive Payment Reform program for independent primary care. The evaluation brief was submitted on September 15, 2023 and the executive summary is posted here:
Federal Evaluation Concludes OneCare is Driving Down Health Care Costs
According to an independent analysis by NORC at the University of Chicago commissioned by the Centers for Medicare & Medicaid Services (CMS) Innovation Center, OneCare Vermont successfully drove down costs and hospitalizations over four years. Key findings:
- Reduced gross spending for Medicare beneficiaries in the ACO and beneficiaries statewide over the first four years of the ACO
- Lowered hospitalizations and unplanned hospital readmissions for Medicare beneficiaries in the ACO
- Achieved key financial targets for Medicare and all-payer total cost of care, limiting growth rates well below national projections.
- Provided an important mechanism to continue collaboration and health care delivery transformation activities preceding the model.
Overview:
Delivering Quality in Health Care
As an accountable care organization, OneCare aims to improve quality while stabilizing costs. Quality measures help OneCare assess health care processes, outcomes, and patient perceptions linked to high-quality health care delivery. OneCare is accountable for both the quality and cost of health care and is committed to supporting providers as they work to reach quality targets.
Each year, health care organizations and providers in OneCare work together to meet quality measures. Organizations participating in OneCare may earn financial incentives for meeting or exceeding quality benchmarks.
How OneCare Vermont Improves Quality
Quality Measures
OneCare works to align quality measures across its payer programs and uses two types of quality measurement standards. Pay for Reporting measures are those that OneCare is required to report by accurately submitting quality measurement information. Pay for Performance measures are used to determine financial incentives available to participants based on overall quality measure scores.
OneCare measures quality in four areas chosen by the Centers for Medicare and Medicaid Services. These areas are:
- Patient/caregiver experience
- Care coordination/patient safety
- Preventive health
- At-risk populations
Annual Quality Plan
Every year, OneCare develops a Quality Work Plan which includes quality assurance activities, performance measurement,
To support quality improvement over time, OneCare performs quality activities on behalf of the OneCare community of providers.
Quality Assurance activities focus on
Performance Measurement activities include the annual collection of quality measurement data. Quality measure collection uses a payer level random sampling of patients that are reviewed for provider adherence to best practice guidelines.
Performance Improvement activities support the development and continuous improvement of a provider-driven, integrated health care delivery system structured at the local community level.
2022 Results for Quality Measures
Summary:
Annual quality measure results consist of payment and reporting measures throughout four domains:
- Patient/Caregiver Experience
- Care Coordination/Patient Safety
- Preventive health
- At-Risk Population.
OneCare was successful in complete reporting for all quality measures for each payer program in performance year 2022.
Quality points are awarded based on performance against applicable benchmarks for all payment measures where those designated as reporting did not impact the ACO overall performance rate.
Blue Cross Blue Shield of Vermont Qualified Health Plan (QHP) and Primary
Both plans maintained reporting status during 2022 for their designated quality measures. While benchmarks were available, no points will be rewarded.
2022 Scorecards
Medicare, Vermont Medicaid Next Generation & MVP Qualified Health Plan
In performance year 2022, these programs contained quality measures with payment or reporting status and applicable benchmarks where OneCare achieved quality points based on performance against aligned benchmarks. There were a few instances where measures without benchmarks achieved quality points due to “payment status.”
2022 Scorecards
Quality Measure Scorecards by Payer
What is shared savings?
The goal of the Vermont All-Payer ACO Model is to move the health care delivery system from volume-based to value-based payments. Providers are eligible to receive savings for meeting performance goals. If Shared Savings are earned, 100% of the savings are reinvested in OneCare network participants.
How does shared savings work?
Each year, OneCare sets a budget with payers for the cost of health care for a population. If the cost of health care for that population exceeds the set amount, OneCare pays the overage back to the payer. If the cost of health care is lower than the budgeted amount, the savings stay with OneCare and is reinvested in the provider community. This provides for predictability and stability in health care spending.
OneCare does not keep savings. Funds are reinvested in the provider community to offset investments already made, to develop and enhance population health programs, and to offset risk.
2022 Results for Shared Savings
Medicare
Participating providers earned a total of $9.6 million in Medicare shared savings from collaborative work to improve beneficiaries’ outcomes and overall health of the Medicare population. Of the $9.6 million, OneCare paid $9.1 million of advanced shared savings throughout 2022 to fund the Patient Centered Medical Home, Community Health Team, and SASH population health management payments. The remaining $0.5 million was distributed directly to primary care providers.
Medicaid
Participating providers earned a total of $6.2 million in Medicaid shared savings. Upon receipt of the payment from Medicaid, $1.7 million will be paid to primary care practices and $4.5 million will be paid to the risk bearing hospitals. Additionally, providers accepting a fixed payment were able to operate in a manner that generated $8.7 million of savings relative to the fixed payment amount.
BlueCross BlueShield of Vermont
The 2022 programs continued with risk protections linked to the pandemic. In sum, the result of the performance year is a requirement for OneCare invest $75k in continued improvement activities.
MVP QHP
The MVP program was structured as an upside-only program in 2022, and no shared savings were earned.
Combined Shared Savings and Losses for Performance Year 2022
| Medicare | ||
|---|---|---|
| Settlement Payment* | $9,574,335 | |
| % of TCOC | 2% | |
| Fixed Payment Performance | $0 | |
| Combined Result** | $9,574,335 | |
| Medicaid | ||
|---|---|---|
| Settlement Payment* | $6,158,305 | |
| % of TCOC | 1.9% | |
| Fixed Payment Performance | $8,678,478 | |
| Combined Result | $14,836,783 | |
| BlueCross BlueShield of Vermont QHP | ||
|---|---|---|
| Settlement Payment* | $0 | |
| % of TCOC | 0% | |
| Fixed Payment Performance | $0 | |
| Combined Result | $0 | |
| BlueCross BlueShield of Vermont Primary | ||
|---|---|---|
| Settlement Payment* | ($75,000) | |
| % of TCOC | 0.03% | |
| Fixed Payment Performance | No fixed payment | |
| Combined Result | ($75,000) | |
| MVP QHP | ||
|---|---|---|
| Settlement Payment* | $0 | |
| % of TCOC | 0% | |
| Fixed Payment Performance | No fixed payment | |
| Combined Result | $0 | |
* Settlement payment amounts incorporate any applicable risk corridor constraints and/or sharing factors per contract terms.
** (Note on Medicare Combined Result) OneCare was paid $9.1 million of advanced shared savings throughout 2022. 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.