Vermont officials outline AHEAD payment-reform terms, warn of risks and unresolved issues

Jenny Samuelson, secretary for the Vermont Agency of Human Services, told the Health Care Reform Oversight Committee on the AHEAD model that the state has negotiated higher baseline funding and targeted primary‑care investments with the Centers for Medicare & Medicaid Services (CMS) but has not committed to the model.

The term sheet the state and CMS released proposes a hospital global‑budget approach, a per‑member‑per‑month (PMPM) primary‑care payment and a statewide equity and transformation pool the presenters called the EAST Fund (Equity, Access and Statewide Transformation Fund). ‘‘We are not committing to this model here,’’ Samuelson said, adding that Vermont remains in negotiations and will decide whether to sign later this winter.

The nut of the AHEAD proposal, as described by Samuelson and Pat Jones of the Department of Vermont Health Access, is to create statewide accountability for total cost of care and to return negotiated Medicare savings into the state to fund investments. ‘‘The total cost of care includes your basic Medicare Part A and Part B type services,’’ Jones said, listing inpatient, outpatient and professional services as examples. Samuelson said the state negotiated roughly $138,000,000 more than current Medicare spending as a baseline increase. She also described a PMPM primary‑care investment the term sheet estimates at about $15 to $21 per member (a…