Results
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
See OneCare’s quality measures for: 2022, 2021, 2020, and 2019. For more information about Vermont’s progress toward achieving the All-Payer Model Agreement targets, click here for 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.
2021 Results for Quality Measures
Summary:
The health care system continues to experience major disruptions during the public health emergency. Many health care providers focused their efforts to help prevent the spread of illness, treat patients with COVID-19, and provide care to high-risk patients.
Because of this change in focus, two insurance payers (Medicare and BCBS) made quality results “reporting only” for 2021. For these payers, this means that OneCare reports quality scores for the year and payments are not adjusted based on those quality scores.
Vermont Medicaid Next Generation
For the Vermont Medicaid Next Generation program, quality measures returned to a payment basis for 2021. Here is the scorecard, with benchmarks included.
Blue Cross Blue Shield of Vermont Qualified Health Plan (QHP) and Primary
For both BCBSVT QHP and BCBSVT Primary programs, 2021 remained reporting only. While benchmarks are available, no points will be awarded. Here is the scorecard for BCBSVT QHP and here is the scorecard for BCBSVT Primary.
Medicare
For Medicare, 2021 is reporting only. Regardless of performance against benchmarks, full points will be awarded. Here is the scorecard.
MVP Qualified Health Plan
2021 is the second year for quality collection for the MVP program. All measures were considered payment measures because this is an upside-only risk contract. Here is the scorecard.
Quality Measure Scorecards by Payer
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.
2021 Results for Shared Savings
Medicare
Participating providers earned a total of $10.0 million in Medicare shared savings from collaborative work to improve beneficiaries’ outcomes and overall health of the Medicare population. Of the $10.0 million, OneCare paid $8.8 million of advanced shared savings throughout 2021 to fund the Patient Centered Medical Home, Community Health Team, and SASH population health management payments. The remaining $1.2 million will be distributed directly to providers, with $1.0 million going to primary care and the remaining $200k going to the risk bearing hospitals.
Medicaid
Participating providers earned a total of $4.3 million in Medicaid shared savings. Upon receipt of the payment from Medicaid, $1.5 million will be paid to primary care practices and $2.8 million will be paid to the risk bearing hospitals. Additionally, providers accepting a fixed payment were able to operate in a manner that generated $2.8 million of savings relative to the fixed payment amount
BlueCross BlueShield of Vermont
The 2021 programs continued with risk protections linked to the pandemic. In sum, the result of the performance year is a requirement for OneCare invest $110k in continued improvement activities
MVP QHP
The MVP program was structured as an upside-only program in 2021, and no shared savings were earned.
Combined Shared Savings and Losses for Performance Year 2021
| Medicare | ||
|---|---|---|
| Settlement Payment* | $10,026,241 | |
| % of TCOC | 2% | |
| Fixed Payment Performance | $0 | |
| Combined Result** | $10,026,241 | |
| Medicaid | ||
|---|---|---|
| Settlement Payment* | $4,333,465 | |
| % of TCOC | 1.6% | |
| Fixed Payment Performance | $2,790,821 | |
| Combined Result | $7,124,287 | |
| BlueCross BlueShield of Vermont QHP | ||
|---|---|---|
| Settlement Payment* | ($50,000) | |
| % of TCOC | 0.04% | |
| Fixed Payment Performance | No fixed payment | |
| Combined Result | ($50,000) | |
| BlueCross BlueShield of Vermont Primary | ||
|---|---|---|
| Settlement Payment* | ($60,000) | |
| % of TCOC | 0.02% | |
| Fixed Payment Performance | No fixed payment | |
| Combined Result | ($60,000) | |
| 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 $8.8 million of advanced shared savings throughout 2021. 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.