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AHEAD Application Submitted

Waterbury, VT – Today the Agency of Human Services applied on behalf of the State of Vermont for the Center for Medicare and Medicaid Innovation’s States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. This is an important step in Vermont’s broader health care reform landscape – and allows Vermont to collaborate with the federal government to impact how Medicare, the health insurer for 21% of Vermonters, pays hospitals, supports primary care, improves health equity, and allows flexibility in how care is delivered. 

“This application offers Vermont an opportunity to continue our long-standing partnership with the federal government, with the potential to advance promising payment and care delivery approaches for hospitals, make critical investments in primary care, and sustain important Medicare resources for Vermonters with Medicare,” said Jenney Samuelson, Secretary of the Agency of Human Services. “Vermont’s most recent negotiation with Medicaid, the jointly funded federal and state program that covers 24% of Vermonters, ended in an excellent agreement – investing millions into Vermont’s systems of care including public health, primary care, long-term services and supports, and mental health and substance use disorder treatment. If we are selected for the AHEAD Model, we will push for favorable Medicare terms that support our rural health care needs, and result in affordable, accessible and high-quality care for Vermonters.” 

The model requires the participation of providers and payers. Vermont added letters of support from the Legislature, and letters of interest from the UVM Health Network, Rutland Regional Medical Center, and BlueCross BlueShield of Vermont. 

“As we look to the end of the All-Payer ACO Model in Vermont, we must continue the momentum toward meaningful payment reform to address longstanding obstacles to the care our patients’ need, better manage health care costs for patients and hospitals, and to support our population health goals of providing patients and their families the care they need when and where they need it,” said Sunny Eappen, MD, MBA, President and Chief Executive Officer of University of Vermont Health Network. “We are excited to submit this Letter of Intent as an essential part of the State’s application process and we look forward to working with the State on how to make AHEAD work for Vermonters.”  

“Vermont has been on a continued journey towards meaningful payment reform for many years and leads the nation in these initiatives. It is vital that Vermont hospitals are financially stable, sustainable, and have an opportunity to grow to meet the increasing healthcare needs of Vermonters,” said Judi K. Fox, President and Chief Executive Officer of Rutland Regional Medical Center. “We believe that the AHEAD model has the potential to be a significant step forward to important payment and care delivery reforms. We appreciate the opportunity to partner with and support the State to explore pathways that will better serve our patients, our communities, our region, and Vermonters”.  

“The legislature, Administration, GMCB, and community partners must work together on policies for equitable access to high quality, affordable health care. AHEAD’s federal support of hospital global budgets and payment improvements for primary care could improve access and quality of care, while ensuring provider and hospital financial sustainability. Ultimately Vermonters will save money,” said Senator Virginia Lyons, Chair of the Committee on Senate Health and Welfare. 

If Vermont is selected by CMMI to move forward with AHEAD, negotiations will commence in June or July of 2024. If CMMI and the State agree on terms, a final agreement would have to be in place by July 2025, in advance of the start of the first performance year on January 1, 2026. AHEAD would be in place for up to nine performance years, through 2034. The intent is to allow adequate time for changes in care delivery to be designed and implemented and for those changes to impact outcomes for the state’s residents.  

If implemented, the AHEAD model would change how we pay for care with a focus on quality, affordability, investment in primary care, and collaboration between providers. That means access to more affordable and well-coordinated care, with a focus on primary care and supports that keep Vermonters and their families healthy. AHEAD will also support investments in important community services.