On July 10, 2024
State News

Vermont selected for new federal model to improve health care affordability and quality

The Centers for Medicare & Medicaid Services (CMS) announced July 2 that it has accepted Vermont’s application to participate in the states advancing All-Payer Health Equity Approaches and Development (AHEAD) program. AHEAD offers Vermont an opportunity to collaborate with the federal government to impact how Medicare, the health insurer for 24% of Vermonters, pays for care with a focus on quality, affordability, investments in primary care and community services, and collaboration between providers.

“This selection is a testament to our agency’s long-standing partnership with the federal government and their support of our efforts to advance new flexible payment and care delivery approaches that result in more affordable, accessible and high-quality care for Vermonters, hospitals, and primary care providers. We look forward to working with CMS to design a model that addresses the needs of Vermonters,” said Jenney Samuelson, secretary of the Agency of Human Services.

Vermont’s selection for AHEAD is the first step in a multi-year process to work with CMS to design a model that works for Vermont, rather than taking a one-size-fits-all approach. After a detailed negotiation process, Vermont will evaluate whether to participate in the model. If the state moves forward with this model, an agreement outlining the terms of the program would have to be in place by July 1, 2025, prior to implementation on Jan. 1, 2026.

This opportunity is a component of Vermont’s broader health care reform to address critical health care needs: making health insurance and health care affordable, ensuring that Vermonters can get care when needed, improving the quality and experience of care, improving work life for health care providers, and keeping all Vermonters healthy and well. The new national model builds upon the innovative work of states.

Building upon the all-payer model, AHEAD will require participation from both providers and payers. AHEAD provides flexibility and predictability to Vermont’s hospitals by setting payments in advance, allowing strategic allocation of resources to address community needs.

High-quality care is incentivized by providing payments to hospitals and primary care practices based on quality measures.

“The selection of Vermont by CMS to begin the detailed process of negotiating and building an AHEAD model agreement is an important step in determining whether this program is the right fit to support the delivery of high quality and equitable care to our patients,” said Sunny Eappen, MD, MBA, president and chief executive officer of University of Vermont Health Network.

AHEAD would be in place for up to nine performance years, from 2026 through 2034, allowing time for changes in care delivery to be designed, implemented and for those changes to impact outcomes for Vermonters.

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