Milestone: CHAC Abandons its ACO

by Hamilton E. Davis

   CHAC, an organization of federally-supported primary care doctors, announced yesterday that it would abandon its five-year effort to operate its own Accountable Care Organization (ACO) in a challenge to the primacy of the much larger ACO OneCare Vermont, which is spearheading the health care reform effort in Vermont.
   CHAC spent two years negotiating with OneCare about establishing a single, overarching ACO to manage the transition from fee-for-service financing for health care to block financing, or capitation, before walking away from the effort earlier this year.
  The decision Wednesday by the CHAC board does not commit any of its member primary care doctors to participating in any of OneCare’s capitation contracts, but it clears away the single most important barrier to that development. And the CHAC press release asserts the organization’s support for the so-called All Payer Model, the putative structure of the Vermont reform effort.
   The first step in the reform effort is now underway in the form of a contract between OneCare and the state’s Medicaid agency to deliver all the medical services necessary to 31,000 Medicaid recipients in the northwest quadrant of the state for a fixed price of $93 million.
   OneCare recently announced that the reform effort would expand to roughly 120,000 Vermonters as of Jan. 1, 2018. That would include people whose health care is paid for by Medicare and private insurance, as well as Medicaid. The areas of the state involved as of Jan. 1 would grow to include the southern tier of Windham and Bennington counties, as well as some sectors along the state’s border with New Hampshire.
   The coverage is patchy, however, owing to the CHAC effort to maintain its own ACO. As of Jan. 1 there will essentially be no reform in Rutland County, nor in the areas served by Gifford Hospital in Randolph, or Copley Hospital in Morrisville. Under federal law, residents cannot be attributed to an ACO unless referred there by a primary care doctor.
   Nonetheless, the CHAC decision marks a significant milestone in what has become a grinding campaign to recast the health care delivery system in the state. I will assess the new development in greater detail next week, but I am appending here the CHAC press release since I have seen no notice of it in the state’s press.   

For Immediate Release

Contact: Dan Bennett, CHAC Board Chair

(802) 728-2304

October 18, 2017 -- MONTPELIER, VT – On October 18, 2017, the Board of Community Health Accountable Care, LLC (CHAC) decided to terminate its Medicare Accountable Care Organization Shared Savings Program agreement with the Centers for Medicare and Medicaid Services, effective 1/1/2018 and to conclude ACO operations. Vermont’s health centers will continue to work together with the state and their community partners to improve the health of the patients that they serve. This will include continued focus on the clinical goals of Vermont’s All-Payer Model.

“CHAC has always believed that a strong primary care system working with other community organizations is the cornerstone to a healthier Vermont and more effective health care system. CHAC is proud of our record, particularly on behalf of the Medicaid patients we served,” notes Dan Bennett, CEO of Gifford Health Care and Chair of the CHAC Board. In August, the Green Mountain Care Board announced that for the third year in a row, CHAC reduced the total cost of care associated with its Medicaid patients, achieving savings for Vermont’s Medicaid Program. Between 2014 and 2016, CHAC’s average total cost of care (expressed as a “per member per month” average) declined by approximately 5%, from $189.83 PMPM (2014) to $180.53 PMPM (2016). At the same time that CHAC reduced the Medicaid dollars spent on care, CHAC implemented clinical quality improvement guidelines in the areas of Congestive Heart Failure, Diabetes, Chronic Obstructive Pulmonary Disease, Depression Screening and Treatment, Falls Risk Assessment, and Colorectal Cancer Screening, and CHAC demonstrated significant quality improvement on quality of care measures.

CHAC’s Board determined that they would make a greater impact for their patients and in support of Vermont’s All-Payer Model by focusing on local collaborations and continuing their joint work on quality improvement and health reform readiness. Vermont’s health centers and their community partners will continue to meet regularly to develop and implement evidence-based clinical recommendations, analyze data for purposes of health improvement and cost management, and learn from each other’s innovative work. “We have numerous opportunities every day to do good work on behalf of our patients in our respective communities and as a statewide network of health centers and primary care providers,” notes Pam Parsons, CEO of the Northern Tier Center for Health and Vice Chair of the CHAC Board. 

CHAC will be winding down its ACO contracts in the coming months and will ensure an orderly close-out for all 2017 ACO programs, including the Medicare Shared Savings Program.

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