Quality measures help OneCare assess health care processes, outcomes, and patient perceptions linked to high-quality health care delivery.
Each year, health care organizations and providers in OneCare work together to meet quality measures. Organizations participating in OneCare receive support from OneCare as they work to reach quality targets and they may earn financial incentives for meeting or exceeding quality benchmarks.
Annual Quality Plan
OneCare develops an annual 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.
2020 Results for Shared Savings
Medicare
Participating providers earned a total of $16.3 million in Medicare shared savings from collaborative work to improve beneficiaries’ outcomes and overall health of the Medicare population.
Of the $16.3 million, OneCare paid over $8.4 million of advanced shared savings throughout 2020 to fund the Patient Centered Medical Home, Community Health Team, and SASH population health management payments.
The remaining $7.9 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 earned shared savings for the 2020 program year, $11.6 million of which was in a settlement payment to the OneCare Vermont ACO.
BlueCross BlueShield of Vermont
For 2020, BCBSVT paid OneCare a $125,000 settlement payment.
MVP QHP
For 2020, MVP paid OneCare a $1,063,182 settlement payment.
Combined Shared Savings and Losses for Performance Year 2020
| Medicare | ||
|---|---|---|
| Settlement Payment* | $16,313,471 | |
| % of TCOC | 4% | |
| Fixed Payment Performance | $0 | |
| Combined Result** | $16,313,471 | |
| Medicaid | ||
|---|---|---|
| Settlement Payment* | $11,621,236 | |
| % of TCOC | 3.6% | |
| Fixed Payment Performance | $43,738,036 | |
| Combined Result | $55,359,272 | |
| 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* | $75,000 | |
| % of TCOC | 0.04% | |
| Fixed Payment Performance | No fixed payment. | |
| Combined Result | $75,000 | |
| MVP QHP | ||
|---|---|---|
| Settlement Payment* | $1,063,182 | |
| % of TCOC | 2.3% | |
| Fixed Payment Performance | No fixed payment. | |
| Combined Result | $1,063,182 | |
* Settlement payment amounts incorporate any applicable risk corridor constraints and/or sharing factors per contract terms.
** OneCare was paid $8.4 million of advanced shared savings throughout 2020. 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.