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Governor Scott Unveils Medicaid Pilot Program

Vermont Governor Phil Scott
Pat Bradley/WAMC
Governor Phil Scott announces Medicaid pilot program

Vermont Governor Phil Scott was joined by his Human Services Secretary and several health care providers today to unveil a pilot Medicaid program intended to change the current fee-for-service system.
The Accountable Care Organization financial model pilot initiative sets up a new reimbursement methodology for Medicaid.  Governor Scott, a Republican who took office last month, says it’s another step in his efforts to reduce health care costs and save Vermonters money while improving care.  “Last year the state put out a Request for Proposal to accountable care organizations to pilot a payment model that makes advance payments for Medicaid patients. As a result we have now entered into a one year agreement with OneCare. As an Accountable Care Organization OneCare will contract with the Department of Vermont Health Access, or DVHA, to provide services to 30,000 Medicaid beneficiaries on a perspective payment schedule. This agreement allows us to gauge the impacts of an all-payer model designed to reward value, meaning low cost and high quality care, rather than volume under a one year pilot program.”

Four hospitals, federally qualified health centers, independent practices, skilled nursing agencies, home health providers and designated agencies will work with the Vermont Department of Health Access and OneCare on a pilot program with 30,000 Medicaid patients.  

Porter Medical Center CEO and practicing physician Dr. Fred Kniffin says the pilot is a great step forward for both patients and the hospital.  “From an administrator's point of view we think it's going to be good for our community. And we want to move from treating our friends and neighbors when they're sick and injured to keeping them healthy. And this supports our mission in that respect. As a practicing physician we want to focus on keeping patients healthy and this sort of program is going to support us in that direction.”

Human Services Secretary Al Gobeille says there is no risk to the patients involved in the pilot.   “It will be financially transparent to the patients in that they won't see any difference in how their care is delivered. The one thing that I would say, and we're already starting to see this, is we shift away from a fee-for-service we’ll patch you up when you're injured or sick model and get to a keeping you healthy model. You're going to have a much different relationship with your primary care provider practice because as Dr. Kniffin said we're really all about now trying to keep you healthy and not just be there when you’re sick.”

If the $93 million pilot meets planned goals at the end of the year, the state will expand it.  If it does not meet operational concerns the administration will not move forward.