The Vermont Health Care Innovation Project (VHCIP) Accountable Care Organization (ACO) Commercial and Medicaid Shared Savings Programs (SSPs) were initiated on January 1, 2014. The VHCIP SSPs are performance-based payment and delivery system reform programs. The ACOs are responsible for redesigning care processes and improving the efficiency and effectiveness of care. In return, they are to be rewarded by sharing with the participating payers in any savings the ACOs generate. The participating payers are Blue Cross Blue Shield of Vermont (BCBSVT) and the Department of Vermont Health Access (DVHA), the state Medicaid agency. The participating ACOs are Community Health Accountable Care (CHAC), OneCare Vermont (OneCare), and Vermont Collaborative Physicians (VCP). This page provides key documents and resources related to implementation of the VHCIP SSPs. These documents may be updated from time to time.
Contracts and Agreements
BCBSVT has executed three-year contracts with all three ACOs, while DVHA has executed contracts only with CHAC and OneCare.
Executed contracts and agreements between DVHA and ACOs participating in the pilot may be accessed via the links below. In addition, the commercial contract template may be accessed via the link below.
ACO Pilot Standards
“Commercial ACO standards” relate to the management and governance of the ACOs participating in the pilot with commercial insurers. They were developed prior to the start of the SSPs and have been incorporated into the BCBSVT-ACO agreements. Much, but not all, of the standards content has been incorporated into the DVHA ACO standards. Accessed via the link below, these standards describe governance requirements, the payment methodology, method for attributing patients to ACOs, calculation of shared risk payments, and provisions to ensure ACOs’ financial stability under the program. In addition, the standards specify the process for review and modification of quality and performance measures used in the pilot program. Comparable standards for the Medicaid ACO program play a similar role and can also be accessed via the link below.
Shared Savings Methodology
The process, methodology, and timeline for assessment of ACO financial performance and for distribution of any earned shared savings payments is described in Section VI of the Commercial ACO Standards (see link above), with additional detail provided in the following two documents:
- ACO shared savings methodology - Excel model
- Timeline and process for calculation of ACO financial performance and payment distribution
Statewide Analytics Activities Vendor
The Green Mountain Care Board, in coordination with DVHA, has contracted with a firm to perform analysis related to the implementation, monitoring, reporting, and evaluation of the VHCIP SSP. The solicitation for proposals from qualified vendors to provide analytic services is found via the link below. The timeline and process by which the analytics contractor will be reporting on ACO performance is described in the second link below.
Performance Measures
The VHCIP Quality and Performance Measures Work Group oversees development of measure sets related to the SSP. The Core Measure Set consists of those measures for which each ACO participating in the Vermont ACO pilot program has accountability for payment and reporting purposes. Within the Core Measure Set, payment measures are those for which ACO performance potentially impacts the amount of shared savings that the ACO may retain. Reporting measures are used to assess ACO performance, but without direct financial implications. The Monitoring and Evaluation Measure Set consists of state-level quality measures, as well as ACO-specific cost and service utilization measures. Specifications for the measures comprising these measure sets are found via the links below.
- ACO Core Measure Set Narrative Specifications
- Monitoring and Evaluation Measure Set Narrative Specifications
- Monitoring and Evaluation Measure Set Narrative Specifications - Cost Measures
Statewide baseline data, benchmarks and performance targets for each of the payment measures for Year 1 of the Commercial and Medicaid ACO pilots (CY2014) may be accessed via the links below.
Performance Measurement Results
The Green Mountain Care Board will publish the Year 1 (performance period CY2014) quality, cost and utilization performance results for each of the ACOs in the autumn of 2015.
ACO and Payer Reporting Requirements
Standards for documents that ACOs and payers must periodically submit to report on enrollment, participating providers, patient attribution, and performance measurement are detailed in “Data Use Report Standards for ACO Pilot,” accessed via the link below.
Detailed timelines for reports required of both payers and ACOs participating in the VHCIP SSP are provided below.