MONTPELIER, Vt. – About 30,000 of Vermont's Medicaid patients will take part in a pilot project that will test a new health care payment system designed to reward providers for keeping patients healthy, rather than paying them to cure people who are already sick, Gov. Phil Scott said Wednesday.
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The yearlong project with the "accountable care" organization OneCare Vermont will pay participating health care providers a set fee for each patient in the program. Within limits, if that person's care costs more than the fee, the provider will have to make up the difference. If it costs less, the provider will benefit.
"It will allow providers to dedicate more time and energy to patients by eliminating some of the time doctors and administrators spend on claims," Scott, a Republican, said during a news conference at the Statehouse.
If the program is successful, the program will be expanded. If it doesn't work as hoped, it can be modified as needed, officials said.
The total cost of the program is estimated to be $93 million in state and federal funds.
The Medicaid patients participating in the program will come from the regions served by four community hospitals: Porter Medical Center in Middlebury, The University of Vermont Medical Center in Burlington, Northwestern Medical Center in St. Albans and Central Vermont Medical Center in Berlin.
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The project is part of an effort by Vermont political leaders and health care officials to restructure the state's health care system to reduce costs while keeping people healthier.
Vermont Human Services Secretary Al Gobeille said that while accountable care organizations have been operating in the state for some time, this pilot project marks the first time one has agreed to risk losing money if it fails to provide care within the limits set by the program.
In addition to changing the way care is paid for, the new system encourages health care providers to work with patients on a regular basis to stay healthy.
UVM Medical Center CEO Dr. John Brumsted said that under the new system, patients will have a much different relationship with their health care providers.
"There's a lot more reaching out, you know, coaching and working, and that's the difference that people are going to see with this model because ... we're really all about now trying to keep you healthy and not just be there when you are sick," Brumsted said.