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.

OneCare’s quality improvement team consults with individual providers to review data and identify areas for improvement. Together with providers, OneCare offers best practices and strategies that can make a difference in health outcomes. 

Quality Measures & Payment Structures

Measurement Focus Areas:

OneCare works with a total of eighteen quality improvement measures as defined by the payers OneCare contracts with on behalf of our participating providers (Medicaid, Medicare, Blue Cross Blue Shield of Vermont, and MVP). These measures span the following domains:

  • Patient/caregiver experience
  • Care coordination/patient safety
  • Preventive health
  • At-risk populations

See OneCare’s quality measures for: 2022, 2021, 2020, and 2019. For more information about Vermont’s progress toward achieving the All-Payer Model Agreement targets, click here for reports on the Green Mountain Care Board website.

Payment Rewards for Quality Improvement:

OneCare works to align quality measures across its payer programs (Medicaid, Medicare, and commercial insurers) 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 measure are used to determine financial incentives available to participants based on overall quality measure scores.

Value-Based Incentive Fund:

Of the eighteen quality improvement metrics OneCare monitors, four are tied to OneCare’s own Value-Based Incentive Program (VBIF). This program gives providers an opportunity to earn incentives for attaining quality performance thresholds determined by OneCare based on recognized benchmarks.

The 2022 VBIF program focuses on measures that address management of hypertension and diabetes for adults and screening of developmental milestones and depression for pediatrics.

When providers are reimbursed for value of care instead of volume of services, over time, they can change the way they deliver health care by investing in traditionally non-billable health care activities that are designed to lead to better health outcomes.

Payment Utilization

How Providers Utilize Funding from OneCare to Improve Care

Providers are incentivized to add value, not so they can make more money, but so they can provide better care. To offer some examples, a provider can utilize shared savings, funding from VBIF, care coordination funding, and/or fixed payment revenue from OneCare to:

 

  • Hire a care coordinator to help ensure their high-risk patients’ providers are communicating with one another about a holistic care plan.
  • Employ a social worker to help connect patients with food, housing, transportation, mental health care, etc., as a means of improving their overall health and well-being.
  • Incorporate a “lifestyle medicine” nurse practitioner into the practice staffing model to help patients with diabetes make lifestyle changes to lower their blood sugar levels, or to help those at risk of serious cardiac events improve diet, exercise, and stress management.
  • Use creative staffing models funded by value-based care allow to continually improve quality of care, leading to better health outcomes while flattening the cost curve.

Monitoring & Results

To monitor progress, annual quality scorecards determine how we are doing across our network of participating providers under each payer and their respective quality measures. When we do well on quality and reduce cost of care, we have “shared savings” that we distribute back to participating providers.