Vermont

Beginning in the 2005-2006 Vermont Legislative Session, health care reform in the State of Vermont was launched through the Blueprint for Health (Blueprint). In 2007, with the participation of Vermont’s three largest commercial payers and Medicaid, the legislature authorized pilots to test an Integrated Health Services Model (the Bluprint model). The Blueprint model includes advanced primary care in the form of Patient Centered Medical Homes (PCMHs), multi-disciplinary support services through Community Health Teams (CHTs) which support PCMHs, multi-insurer payment reforms that fund PCMH transformation community health teams, and activities focused on continuous improvement using comparative valuation (Learning Health System).

In 2011, Medicare selected Vermont as a participant in its Multi-Payer Advanced Primary Care Practice Demonstration initiative, and agreed to participate in the Blueprint project. The project now includes 79 practice sites serving approximately 360,000 patients, more than half of the state’s population. In 2013, the Blueprint was expanded statewide.

During the last few years, this work continued with enactment of Act 48 (2011) and passage of Act 171 (H.559), signed by Governor Peter Shumlin on May 16, 2012. They put Vermont on a path toward an integrated health care delivery system with a budget regulated by the new Green Mountain Care Board, universally available health insurance coverage that is not linked to employment and a single system for administration of claims and payments to providers.

In addition, Vermont's Request For Proposals for QHPs encourages issuers to include innovative preventive care models in its non-standardized plan designs such as Advanced Primary Care Practices, PCMHs and Community Health Teams.

Primary Care Innovations and PCMH Activity

Dual Eligible	2703 SPA	CPC	CPC+	PCMH QHP	PCMH Legislation	Private Payer

Multi-Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program	Outcomes
Vermont Blueprint for Health	Multi-Payer	Statewide	Multi-Payer Advanced Primary Care Practice (MAPCP)

Public Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
CMS State Innovation Model (SIM) Award - Vermont	Grant	Statewide	CMS State Innovation Model (SIM)
Improving Health Outcomes for Children (IHOC) - Vermont	Grant	Maine, Vermont	CHIPRA Quality Demonstration Grant
Vermont Hub and Spokes Health Homes	Medicaid	Statewide	ACA Section 2703 Health Homes

Private Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program	Outcomes
Cigna Collaborative Accountable Care Program - Fletcher Allen Health Care and Central Vermont Medical Center	Commercial	Burlington	Cigna Collaborative Care Program

State Legislation

Legislation	Status	Year
Act 171 (H.559) The act expresses legislative intent that access to and payments for community health teams should begin at least six months before a medical practice is scheduled to be scored for Blueprint recognition, that the Blueprint director increase payments to medical homes because of new qualification requirements, and that all health plans, including the multistate plans required under the ACA, should participate in the Blueprint for Health.	Enacted	2012
Vermont Act 48 (VT LEG 270379.1) The Act put Vermont on a path toward an integrated health care delivery system with a budget regulated by the new Green Mountain Care Board, universally available health insurance coverage that is not linked to employment and a single system for administration of claims and payments to providers.	Enacted	2011
Senate Bill 53 This bill proposes to require the Green Mountain Care Board to determine the proportion of health care spending currently allocated to primary care, recommend the proportion that should be allocated to primary care going forward, and project the avoided costs that would likely result if that proportion were achieved. It would then direct certain payers to provide a plan for achieving the allocation of primary care recommended for them by the Board. The House and Senate bills differ slightly, with the House bill specifying that primary care be allocated 12 percent or more of spending by 2025.	Enacted	2019
SB 53 Was enacted	Enacted	2019
S. 244 Would require health insurers, the State Employees’ Health Benefit Plan, and the health plans offered to school employees to increase the percentage of total healthcare spending they allocate to primary care to at least 12% and require that Medicaid primary care reimbursement rates match Medicare levels.	Was Not Enacted	2022
S. 84 An Act Relating to Strengthening Primary Care and Primary Care Providers This bill proposes to require health insurers, the State Employees’ Health Benefit Plan, and the health plans offered to school employees to increase the percentage of total health care spending they allocate to primary care to at least 15 percent and would require the next all-payer model agreement with the federal government to include a provision requiring annual increases in primary care spending in Medicare.	Was Not Enacted	2023
H 220 Requires commercial plans covering 500 or more lives, the State Employees Benefit plan and the Green Mountain Care Board to increase the proportion of health care spending allocated to primary care by 1% a year until reaching 12%.	Was Not Enacted	2023
S151 An act relating to pay parity and transparency in health care This multi-issue bill includes provisions to increase primary care payments and spending. It requires that Medicaid matches 100% of the amount that Medicare pays its providers and that state and large health insurers increase their annual spending on primary care until the total reaches at least 12% of overall health care spending.	Was Not Enacted	2023
S. 53 This legislation directed.the Green Mountain Care Board and Department of Vermont Health Access to identify which health care providers and services constitute primary care, determine the percentage of health care spending currently allocated to primary care by certain public and private payers and by Vermont’s health care system overall, and report the percentages and related information to the General Assembly.	Enacted	2019