Projects for Department of Vermont Health Access

Vermont Bundled Payment Program

Service Category: Program Design and OperationsProgram Design and Operations

B&A is providing technical support to Vermont Medicaid on the design and implementation of a bundled payment program for a set of priority episodes of care.

Home Health Payment System

Service Category: Strategic PlanningStrategic Planning

BB&A is providing strategic planning services on the design and implementation of a new value-based home health prospective payment system.

Medical Benefit Payment System Management in Vermont Medicaid

Service Category: Rate SettingRate Setting

B&A supports Vermont Medicaid maintain payment systems for facilities, professionals, laboratories, durable medical equipment providers, ambulance, and non-emergency transportation services. Highlights include transitioning the state to MSDRGs and APCs and continues to support the state in annual updates to policies, budget and systems.

Federally Qualified Health Center (FQHC) Payment System

Service Category:
  • Strategic Planning: B&A is providing strategic planning services on the design and implementation of a new value-based federally qualified health center (FQHC) payment system.
  • Rate Setting: B&A is working with the state of Vermont to design a value-based, prospective payment system for home health services.

Medicaid Shared Saving Program (VMSSP) / Strategic Planning

Service Category: Strategic PlanningStrategic Planning

B&A provided strategic planning services to state staff in support of the design and launch of the Vermont Medicaid Shared Savings ACO Program.

Medicaid Shared Saving Program (VMSSP) / Budget Development and Program Financing

Service Category: Budget Development and Program FinancingBudget Development and Program Financing

B&A designed the financial reporting materials in support the Vermont Medicaid Shared Savings ACO Program including forecasts of the actual and projected per capita spend.

Medicaid Shared Saving Program (VMSSP) / Program Design and Operations

Service Category: Program Design and OperationsProgram Design and Operations

B&A provided Vermont Medicaid technical support in the design and implementation of the Vermont Medicaid Shared Savings ACO Program.

Medicaid Shared Saving Program (VMSSP) / Data and Analytics

Service Category: Data and AnalyticsData and Analytics

B&A supports monitoring and evaluation efforts in Vermont Medicaid by using claims data to conduct policy analysis and calculate performance metrics.

All Payer Models

Service Category: Public/Private Insurance InitiativesPublic/Private Insurance InitiativesStrategic PlanningStrategic Planning

B&A is one of a team of contractors who provide strategic planning services to state staff in support of the exploration and design of all payer waivers and rate setting models including: universal primary care, global hospital budgets and next generation accountable care organizations (ACOs) with a focus on implications for Medicaid.

UPL Calculations for Rebase Project

Service Category: Disproportionate Share and Upper Payment Limit Program Financing

As part of the requirements for submitting a state plan amendment to change OVHA’s inpatient and outpatient reimbursement methodologies, B&A calculated the Upper Payment Limit tests for both systems to ensure federal approval. A methodology was written up to accompany the UPL calculations submitted to CMS.

Waiver Budget Development

Service Category: Budget Development and Program FinancingBudget Development and Program Financing

OVHA hired B&A to reformat its budgeting tool to support the Global Commitment for Health waiver. This new design was accompanied by a budget forecast we completed for the coming fiscal year.

Inpatient and Outpatient Hospital Reimbursement Redesign

Service Category: Rate SettingRate Setting

B&A developed new payment methodologies for inpatient and outpatient hospital services. The previous methodologies had not been substantially updated for 15 years. Activities included developing multiple impacts for hospital CFOs as methodologies developed, facilitating hospital CFO and billing staff meetings on implementation, technical assistance to EDS on pricing algorithms, changes to the state plan and communications with CMS. The inpatient system (DRG) was implemented 1/1/08. The outpatient system (based on Medicare OPPS) was implemented 5/1/08. OVHA recently extended B&A’s contract for an additional year to assist in ongoing maintenance and monitoring.

Update DSH Methodology – OVHA

Service Category: Disproportionate Share and Upper Payment Limit Program Financing

Mark Podrazik assisted Vermont in the redesign and implementation of their disproportionate share program to ensure federal compliance. Alternatives were modeled for the state’s consideration and the change in methodology was implemented in October 2008. A DSH methodology document was delivered to hospitals and procedure manual was produced for OVHA staff to make the DSH calculations going forward.

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