OneCare is committed to innovative payment reform programs, collaborative partnerships, and expert support and assistance to improve access to high-value mental health care and substance use disorder treatment.
Comprehensive Payment Reform (CPR) Mental Health Integration Model
The CPR program is designed for independent primary care practices to receive a fixed payment for their patients attributed to the OneCare Vermont accountable care organization. Fixed CPR payments cover primary care services for the Medicare and Medicaid programs and include a supplemental component for those attributed to OneCare with MVP coverage. There are 19 practice sites participating in the program.
Under the CPR Program Mental Health Integration Model, CPR practices can increase monthly CPR payments from OneCare by committing to additional requirements focused on improving quality and access to mental health care. The requirements include:
- Administering depression, suicide, and anxiety screening with written protocol for positive screening results
- Participating in a five-year plan to improve mental health access in Vermont
- Staffing a psychiatric nurse practitioner, a mental health care manager, a behaviorist, or a community health worker in the primary care office
- Implementing a collaborative care model with other providers in the community
Mental Health Screening Incentive Program
The mental health screening incentive program is designed to:
- Engage primary care practices in standardizing mental health screening protocols
- Collect data on mental health screening rates
- Improve the overall rate of mental health screening
- Encourage appropriate follow-up after positive screens
Partnership with Brightside Health
Increasing access to mental health services for Medicaid beneficiaries
Through additional funding prioritized to increase access to mental health services in Vermont, OneCare Vermont is partnering with Brightside Health to increase access to psychiatry and therapy services.
While the Brightside Health services are available to many Vermonters, the OneCare pilot is specifically focused on Medicaid beneficiaries. Through this collaboration, providers in the OneCare network can refer their patients receiving Medicaid benefits to easy-to-access online therapy appointments. This will not only increase the volume of mental health providers available to the Medicaid population but will also more quickly get patients to the care they need. OneCare provided the start-up funding to for this service through the end of 2024, with the State of Vermont’s Department of Health Access providing the long-term funding needed to sustain the Brightside Health partnership.
Population Health Model
As an Accountable Care Organization (ACO), OneCare has distinct goals to improve the quality of care for Vermonters. OneCare’s Population Health Model (PHM) is designed to focus our OneCare network of participating providers on a subset of quality measures that have known impacts on a population’s overall health outcomes and patient experience by offering financial incentive to meet or exceed the measures’ performance targets and care coordination accountabilities. The selected PHM quality measures work to drive improvements in preventive care, including these three measures that focus on improving mental health and substance use outcomes:
- Follow-Up after ED Visit for Mental Illness-30 Day : The percentage of emergency department visits for members 6 years and older with a principal diagnosis of mental illness or intentional self-harm, who had a follow-up visit for mental illness.
- Follow-Up After Hospitalization for Mental Illness (7 Days): The percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm diagnosis and who had a follow-up visit with a mental health provider.
- Follow-Up after ED Visit for Substance Use – 30-Day: The percentage of emergency department visits for members 13 years and older with a principal diagnosis of substance use disorder, or any diagnosis of drug overdose, for which there was a follow-up.
Designated Agencies are specifically incentivized through these measures in the PHM to follow-up after emergency department (ED) and inpatient hospitalization for mental illness.
Waivers
OneCare Vermont, as an accountable care organization (ACO) participating in Vermont’s All-Payer Model, has been provided waivers that are specific to the Vermont All-Payer Model. These waivers are offered to make it easier for the health care providers who work with OneCare to provide high quality care at lower costs to Vermonters.
Using the waivers, OneCare has been able to support new care delivery projects for patients including increasing access to the right mental health and substance use disorder care. Some of the innovative arrangements OneCare has made possible through approving specific waivers that would otherwise be barriers to care—and in some cases also providing start-up funding—have included:
- Brattleboro Retreat Ambulance Transport: Patients in emergency departments (EDs) were stuck waiting for rides to get the right substance use treatment and mental health care at the Brattleboro Retreat. A participation waiver made it possible for hospitals to pay a local, independent ambulance company to transport patients efficiently and in an appropriate transportation setting by specially trained staff. Learn more about this waiver here.
- Child Psychiatry Consultation Clinic to Support Pediatricians and Primary Care Physicians: A waiver and funding from OneCare made it possible for Community Health Centers of Burlington (CHCB) to operate a child psychiatry consultation clinic providing diagnostic evaluation and consultation to pediatric patients.
- Treatment Paths for Alcohol Use Disorder: With a participation waiver and funding from OneCare, Southwestern Vermont Medical Center and Turning Point partnered to create an alcohol use disorder treatment path from inpatient detoxification through residential treatment after discharge. Patients are supported by trained recovery counselors through the treatment path.
For more information:
Please contact Public Affairs at OneCare Vermont. public@onecarevt.org | 802-847-1346
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