Vermont selected to take part in federal health care reform model

Federal officials have selected Vermont as one of three states to participate in the AHEAD program , a new health care reform initiative, the state announced Tuesday.

It’s not exactly clear what the initiative would entail for Vermont, as the state and federal government have yet to settle on the specifics of a program.

But AHEAD — which stands for States Advancing All-Payer Health Equity Approaches and Development — is intended to cut health care expenditures, increase investments in primary health care and shift how hospitals are reimbursed for care they provide.

Jenney Samuelson, the secretary of Vermont’s Agency of Human Services, welcomed the development in a press release Tuesday. The decision to select Vermont was an endorsement 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 selection,” Samuelson said.

The federal government also selected Connecticut and Maryland to join the model. Participating states are eligible for up to $12 million in federal funding to implement the program.

Vermont officials say it would be a rare opportunity to negotiate with the feds about how the state uses Medicare dollars. Roughly a quarter of the state’s population receives health insurance through Medicare, but that money is subject to strict requirements.

Vermont hospitals participating in AHEAD would also shift how they are paid for administering care. Hospitals are not required to participate, but to join the program, Vermont must have at least one participating hospital.

For a certain program or patient population, such as Medicaid patients, hospitals would receive regular payments of predetermined amounts — rather than charging discrete sums for individual procedures.

The goal is to provide hospitals with a stable income stream and discourage unnecessary procedures.

“The selection of Vermont by (the federal Centers for Medicare & Medicaid Services) 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,” Sunny Eappen, the president and CEO of the University of Vermont Health Network, said in the press release.

Eappen wrote a letter of support for the AHEAD model, as did Rutland Regional Medical Center president and CEO Judi Fox. Those letters are non-binding, however, and hospitals have not yet formally agreed to participate.

AHEAD would also direct more funding toward participating primary care practices and would require Vermont to create a “health equity plan” to cut down on health care disparities across the state, according to the program criteria.

Those investments in primary care would aim to “increase overall capacity for care coordination and connection to community resources, improve quality, offer whole person-centered care, and minimize provider burden,” according to a program fact sheet.

The selection of Vermont does not guarantee that the state will ultimately participate in the AHEAD model. Instead, officials will work with the federal government to hash out a more detailed plan by July 1, 2025.

If Vermont decides to move forward with AHEAD, the program would begin in 2026 and run through 2034.

Read the story on VTDigger here: Vermont selected to take part in federal health care reform model .