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.
OneCare paid $6.3 million in quality payments to health care organizations in 2019. Health care organizations earn quality dollars with high scores on standardized measures of quality.
How We Improve 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
Read OneCare’s 2020 Quality Measures and 2019 Quality Measures. For more information on Vermont’s progress toward achieving the All-Payer Model Agreement targets, click here for the list of reports on the Green Mountain Care Board website.
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.
2019 Results for Quality Measures
- 30 Day Follow-Up after Discharge from the ED for Alcohol and Other Drug Abuse or Dependence
- Developmental Screening in the First 3 Years of Life
- Diabetes Mellitus: Hemoglobin A1c Poor Control (>9%)
- Engagement of Alcohol and Other Drug Abuse or Dependence Treatment
- Hypertension: Controlling High Blood Pressure
- Diabetes Mellitus: Hemoglobin A1c Poor Control (>9%)
Quality Scores for the Medicare 2019 performance year will be released by the Centers for Medicare and Medicaid Services later this year.
2018 Results for Quality Measures
The quality scores that OneCare achieved for 2018 are 85% for Medicaid, 86% BCBSVT QHP (Health Exchange), and 100% Medicare (Medicare was reporting only for 2018). Please note that it is too early in the model to make year over year comparisons of the quality results due to the growth of the population, but we are working on ways to represent progress year-to-year.
Quality Measure Scorecards by Payer
2019 Scorecards
- Vermont Medicaid Next Generation 2019
- BCBSVT Qualified Health Plan 2019
- Vermont All Payer ACO Model 2019 – Quality Scores for Medicare for the 2019 performance year will be released by the Centers for Medicare and Medicaid Services later this year.
Shared Savings
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.
2018 Results for Shared Savings
Shared Savings and Losses for Performance Year 2018
Despite the strong start, OneCare does not expect this outcome each year. The goal is to live on a steady growth rate. To achieve that goal, OneCare will receive funding in the settlement process some years and will owe money in the process other years.
Medicare: $13,345,337 savings (OneCare was paid $7,776,760 of advanced shared savings throughout 2018. These dollars supplied OneCare with funding for the Patient-Centered Medical Home, Community Health Team, and Support and Services At Home population health management payments.)
Medicaid: OneCare Vermont was within approximately 1% of 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 the difference between the Actual Total Cost of Care and the Expected Total Cost of Care, totaling approximately $1.5 million for the 2018 performance year.
BlueCross BlueShield of Vermont: OneCare was within .05% of the budget target and the BCBSVT QHP (Health Exchange) and paid BCBSVT $645,574.