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 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 2021 Quality Measures, 2020 Quality Measures, and 2019 Quality Measures. For more information about Vermont’s progress toward achieving the All-Payer Model Agreement targets, click here for to find 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.
2020 Results for Quality Measures
Quality Measurement During the Public Health Emergency
The health care system experienced major disruptions during the public health emergency. Many health care providers focused their efforts help prevent the spread of illness, treat patients with COVID-19, and provide care to high-risk patients.
Because of this change in focus, the majority of insurance payers made quality results “reporting only” for 2020. This means that OneCare reports quality scores for the year. Quality payments are not adjusted based on quality scores.
Vermont Medicaid Next Generation
For the Vermont Medicaid Next Generation program, 2020 is reporting only and there are no available benchmarks. Here is the scorecard.
Blue Cross Blue Shield of Vermont Qualified Health Plan (QHP) and Primary
For both BCBSVT QHP and BCBSVT Primary programs, 2020 is reporting only, there are no available benchmarks, and no points will be awarded. Here is the scorecard for BCBSVT QHP and here is the scorecard for BCBSVT Primary.
Medicare
For Medicare, 2020 is reporting only, there are no available benchmarks, and full points will be awarded. Here is the scorecard.
MVP Qualified Health Plan
2020 is the first 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.
2019 Results for Shared Savings
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.