Provider: OneCare Vermont
Background: OneCare Vermont is a statewide ACO comprised of a large and diverse provider network who together contract with numerous payer types, thereby covering a wide range of patients and populations. At the time of its inception in 2012, OneCare had been relying on the Hierarchical Conditions Category (HCC) risk adjustment model to estimate patient clinical risk and costs across the health system. However, in 2014 when the ACO entered into its first contract with Vermont Medicaid, it found that the risk adjustment model was insufficient for the new population of patients, particularly pediatric patients, as the HCC model was designed for the Medicare senior adult population. In order to most efficiently allocate resources across its diverse patient population and identify high-risk individuals who could most benefit from enhanced services, OneCare Vermont sought to utilize a risk stratification tool that would apply to all populations.