Network Performance Management

Through network performance management, OneCare establishes value-based care contracts on behalf of participating providers and supports success under those contracts through prevention efforts, care coordination infrastructure, and quality improvement metrics.

Contracting

OneCare’s network performance management core capability includes the crucial first step in what OneCare—as an accountable care organization—offers to its participating providers: contracting. OneCare works with Medicaid, Medicare, and commercial insurers to establish contracts for value-based care for its entire network of over 5,000 providers at hundreds of different organizations. OneCare does all the work to navigate the different ways each insurance contract works. Without OneCare, providers would be left to sort all that out with each payer on their own, requiring providers to each hire their own experts to do so and slowing down the progress of value-based care in Vermont.

Prevention

Population health efforts focus on improving the health of an entire population or a select sub-population. At OneCare, we use data to identify opportunities to improve population health. We recognize that the social determinants of health – things like access to housing, affordable food, and transportation – also influence the health of individuals and their communities.

In 2022, OneCare’s budget outlines a $29 million investment in population health management across the full continuum of care – investments that are made possible through OneCare’s programs. These funds wouldn’t be available without OneCare and our commitment to sustaining investments in population health management, including a focus on preventive care.

In addition to the payments made to participating providers to support primary care services, care coordination, and quality improvement, OneCare invests in prevention programs that lead to improved health outcomes in a population.

Prevention Programs that Improve Health Outcomes

  • OneCare Vermont’s RiseVT program works to prevent chronic disease by promoting healthy behaviors where Vermonters live, work, learn, and play.
  • DULCE (Developmental Understanding and Legal Collaboration for Everyone): OneCare offers funding and partnership for this program which proactively addresses social determinants of health to promote the healthy development of infants from birth to six months of age and provide support to their parents.
  • SASH (Support Services at Home): OneCare provides funding and partnership to support SASH , an organization that coordinates the resources of social-service agencies, community health providers, and nonprofit housing organizations to support Vermonters who choose to live independently at home. Preventive health is the foundation of this success of SASH in keeping Vermonters healthy and independent.
  • Blueprint for Health Patient Centered Medical Homes: OneCare invests in and partners to support Blueprint’s efforts to support primary care practices in achieving and maintaining recognition as Patient Centered Medical Homes under the National Committee for Quality Assurance (NCQA) standards.
  • Blueprint for Health Community Health Teams: OneCare invests in community health teams which supplement the services available in Patient Centered Medical Homes and link patients with the social and economic services that make healthy living possible for all Vermonters.

 

Care Coordination

OneCare’s care coordination model supports care teams in communities. Care coordination requires a strong relationship between the patient, their primary care provider, and other members of a person’s care team. OneCare provides tools and resources to help facilitate this coordination. With OneCare tools and support, providers work together across organizations to help patients access the care they need and avoid expensive duplicate services. Providers share information about what is happening with the patients they are all caring for—if the person is admitted or discharged from the hospital, if social or economic factors put patients at risk, or if a change in their mental health has occurred. That way, providers caring for the same patient can quickly identify ways to address their needs and the patient only has to tell their story once.

OneCare provides the following to support care coordination:

  • Data to help inform primary care providers which patients on their panel may benefit from care coordination
  • Best practices and tools for forming a community- and team-based care coordination model
  • Secure communication tools care coordination team members can use no matter where they work
  • Training for health care workers and partners statewide on care coordination processes and procedure

Fred’s Story: A Case Study of Care Coordination

Quality Improvement

OneCare focuses on the quality of care along with the cost of care. “Quality” in health care refers to the degree to which health care services can increase the desired health outcomes for individuals and populations. At OneCare Vermont, we are building the infrastructure to support and monitor quality improvement efforts across the state.

Network Performance Links to Other Core Capabilities

Illustration - OneCare Core Business Area - Data Analytics. Two data analysts on the left are looking at a large whiteboard covered in infographics and statistics. Next to them is a woman sitting in front of a computer generating detailed analytics.

Core Capability #2:

Data and Analytics

OneCare Vermont makes use of data and analytics by measuring health care cost, quality, and utilization. OneCare measures across an entire population of patients to help providers identify which Vermonters need outreach and which areas of care delivery to improve.

OneCare’s data and analytics support care coordination and quality improvement by identifying patients that could benefit from care coordination and specific quality improvement measures to implement.

Illustration - OneCare Core Business Area - Payment Reform. An accountant is looking at her computer and working with a doctor who is standing in front of a large clipboard with quality check marks on it. On the ground behind them are symbols representing money and payment.

Core Capability #3:

Payment Reform

OneCare works with insurers and providers to change how health care services are paid. Under this model, providers can accept regular fixed predictable payments for each patient instead of getting paid for each test or service they perform, and are rewarded based on quality outcomes. When providers are reimbursed for value instead of volume, over time, they can change the way they deliver health care and invest in activities that are designed to lead to better health outcomes—primary care, health prevention, early identification of disease, and the right treatment at the right time.