Article | Partnerships and Value

Payer-provider clinical alignment in Vermont

Article | Partnerships and Value

Payer-provider clinical alignment in Vermont

In Vermont, policymakers have brought together payers and providers to establish meaningful quality measures to improve access to primary care, reduce deaths from suicide and drug overdose, decrease rates of chronic disease and improve chronic disease management. Early results are promising: A 2018 Commonwealth Fund report, Vermont’s Bold Experiment in Community-Driven Health Care Reform, found:

  • High-risk Medicare beneficiaries covered under the state’s all-payer accountable care organization, OneCare Vermont, are using primary care, behavioral health and pharmacy benefits to a greater degree than high-risk beneficiaries not covered under the ACO.
  • Emergency department visits and hospitalizations have decreasedsignificantly among covered beneficiaries.

About the Authors

Emad Rizk, MD

is chairman, president and CEO of Cotiviti, Atlanta (emad.rizk@cotiviti.com). 

Advertisements

Related Articles | Partnerships and Value

Tools & Tips | Finance and Business Strategy

What to know before rolling out a PSHP

Healthcare organizations that are launching a provider-sponsored health plan should consider four recommendations.

Article | Finance and Business Strategy

Providers explore new territory with health plan ownership

Health systems are showing renewed interest in forming provider-sponsored health plans for a number of reasons, including rising enrollment in Medicare Advantage plans and discontent with payer-provider partnerships.

Column | Finance and Business Strategy

Why it is necessary to routinely assess healthcare integration initiatives

Because the perspectives of participants in healthcare integration initiatives can change over time, causing their business and financial needs to move out of alignment, it is important to reassess the integration relationships at regular intervals.

Article | Partnerships and Value

Payer-provider partnerships focused on improving palliative care in California

Payers and providers in California partnered to significantly improve capacity for services and reduce emergency department visits, thereby improving outcomes.