Quality Improvement Results

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, and performance improvement activities. OneCare’s Clinical Quality Advisory Committee helps to prioritize projects aimed at specific patient populations. The Pediatric Subcommittee meets to select strategies and projects designed to improve the health of children in Vermont.

To support quality improvement over time, OneCare performs quality activities on behalf of the OneCare community of providers.

Quality Assurance activities focus on auditing of internal data collection systems and personnel.

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.

Previous Results for Shared Savings