TY - JOUR
KW - accountable care organizations
KW - Health Care Reform
KW - Humans
KW - Medicaid
KW - State Health Plans
KW - United States
KW - Value-Based Health Insurance
KW - Vermont
KW - State Innovation Models
KW - accountable care organization
KW - readiness
KW - system transformation
KW - value-based payment
AU - D. Grembowski
AU - M. Marcus-Smith
A1 - 
AB - Following an arduous, 6-year policy-making process, Vermont is the first state implementing a unified, statewide all-payer integrated delivery system with value-based payment, along with aligned medical and social service reforms, for almost all residents and providers in a state. Commercial, Medicare, and Medicaid value-based payment for most Vermonters will be administered through a new statewide accountable care organization in 2018-2022. The purpose of this article is to describe the 10 conditions that increased Vermont's readiness to implement statewide system transformation. The authors reviewed documents, conducted internet searches of public information, interviewed key informants annually in 2014-2016, cross-validated factual and narrative interpretation, and performed content analyses to derive conditions that increased readiness and their implications for policy and practice. Four social conditions (leadership champions; a common vision; collaborative culture; social capital and collective efficacy) and 6 support conditions (money; statewide data; legal infrastructure; federal policy promoting payment reform; delivery system transformation aligned with payment reform; personnel skilled in system reform) increased Vermont's readiness for system transformation. Vermont's experience indicates that increasing statewide readiness for reform is slow, incremental, and exhausting to overcome the sheer inertia of large fee-based systems. The new payments may work because statewide, uniform population-based payment will affect the health care of almost all Vermonters, creating statewide, uniform provider incentives to reduce volume and making the current fee-based system less viable. The conditions for readiness and statewide system transformation may be more likely in states with regulated markets, like Vermont, than in states with highly competitive markets.
AD - 1 Department of Health Services, School of Public Health, University of Washington , Seattle, Washington.; 2 Division of General Internal Medicine, School of Medicine, University of Washington , Seattle, Washington.
BT - Population health management
C5 - Financing & Sustainability; Healthcare Policy
CP - 3
CY - United States
DO - 10.1089/pop.2017.0061
IS - 3
JF - Population health management
M1 - Journal Article
N2 - Following an arduous, 6-year policy-making process, Vermont is the first state implementing a unified, statewide all-payer integrated delivery system with value-based payment, along with aligned medical and social service reforms, for almost all residents and providers in a state. Commercial, Medicare, and Medicaid value-based payment for most Vermonters will be administered through a new statewide accountable care organization in 2018-2022. The purpose of this article is to describe the 10 conditions that increased Vermont's readiness to implement statewide system transformation. The authors reviewed documents, conducted internet searches of public information, interviewed key informants annually in 2014-2016, cross-validated factual and narrative interpretation, and performed content analyses to derive conditions that increased readiness and their implications for policy and practice. Four social conditions (leadership champions; a common vision; collaborative culture; social capital and collective efficacy) and 6 support conditions (money; statewide data; legal infrastructure; federal policy promoting payment reform; delivery system transformation aligned with payment reform; personnel skilled in system reform) increased Vermont's readiness for system transformation. Vermont's experience indicates that increasing statewide readiness for reform is slow, incremental, and exhausting to overcome the sheer inertia of large fee-based systems. The new payments may work because statewide, uniform population-based payment will affect the health care of almost all Vermonters, creating statewide, uniform provider incentives to reduce volume and making the current fee-based system less viable. The conditions for readiness and statewide system transformation may be more likely in states with regulated markets, like Vermont, than in states with highly competitive markets.
PP - United States
PY - 2018
SN - 1942-7905; 1942-7891
SP - 180
EP - 187
EP - 
T1 - The 10 Conditions That Increased Vermont's Readiness to Implement Statewide Health System Transformation
T2 - Population health management
TI - The 10 Conditions That Increased Vermont's Readiness to Implement Statewide Health System Transformation
U1 - Financing & Sustainability; Healthcare Policy
U2 - 28829924
U3 - 10.1089/pop.2017.0061
VL - 21
VO - 1942-7905; 1942-7891
Y1 - 2018
Y2 - Jun
ER -