Modern Healthcare reports on a Vermont Medicare experiment that has been found to improve patient health and reduce costs. The experiment relies on an all-payer model of health care or, put differently, on bringing all insurers together to pay for health care in an integrated way.
Hospitals and doctors can choose whether they want to participate in the Vermont program. Importantly, all hospitals participate, And, more than half of primary care doctors also participate.
The program gets support from Democrats in the state legislature and Vermont’s Republican governor. It has succeeded at reducing both Medicaid and Medicare costs.
The biggest way to reduce costs is through fewer and shorter hospitalizations. Nearly one in five (18 percent) fewer people with Medicare in Vermont received acute care in hospital. In addition, people receiving acute care were in the hospital 14.7 percent fewer days. And, 12.4 percent fewer people were readmitted to hospital within 30 days. Cost savings were significant at about 6.5 percent.
People with Medicare in Vermont must sign up to participate in this five-year experiment. In 2019, its second year, nearly half of all Vermonters participated.
The experiment relies on a different payment model from fee-for-service. It pays a fixed amount per patient. And, it relies on a patient care team that often includes social workers, changing the way care is delivered.
The Vermont experiment presents challenges and opportunities. How do you pay appropriately for value-based care? What is value-based care? How do you enlist all doctors to participate? Does the payment system create disincentives for providers to treat people with costly conditions? What is the measure of its success? Given that the vast majority of people are relatively healthy and cost our health care system little and just a small minority have complex conditions, requiring expensive treatments, how much do health outcomes for the people who most need care matter?
Here’s more from Just Care:
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