Sunday, March 10, 2013

Medicaid in Vermont

The Department of Vermont Health Access (DVHA) the state’s largest insurer in terms of dollars spent and the second largest in terms of covered lives, manages Medicaid, SCHIP, and other publicly funded health coverage programs in the state. In addition, DVHA is responsible for Vermont’s Blueprint for Health, for HIT strategic planning, coordination, oversight, and to implement the health benefit exchange.

Within DVHA, the Medicaid Health Services and Managed Care Division handles a number of responsibilities such as:

  • The Vermont Chronic Care Initiative identifies and assists Medicaid beneficiaries with chronic health conditions and/or high utilization of medical services. The goal is to access clinically appropriate healthcare information and services and coordinate the delivery of healthcare to the chronically ill
  • The Managed Care Compliance unit is responsible for ensuring compliance with all federal and state managed care requirements
  • Clinical Operations monitors the quality, appropriateness and effectiveness of healthcare services requested by providers for beneficiaries
  • The Pharmacy Unit manages the pharmacy benefit programs for beneficiaries enrolled in Vermont’s publicly funded healthcare programs and ensures that the beneficiaries receive medically necessary medications in a cost effective manner
  • Provider and Member relations ensures that beneficiaries have access to an adequate provider network
  • The Quality Improvement and Clinical Integrity unit collaborates to maintain quality standards as required and prepares for annual external quality reviews
  • The Substance Abuse program coordinates services from members who are recovering form opioid dependence, and administers the Team Care program that links a member to a single prescriber and single pharmacy 
 HP Enterprise Services has just signed a $48 million contract with the Department of Vermont Health Access (DVHA) to continue their 31 year relationship with HP as the state’s Medicaid agent.

Last year, HP processed more than 9.6 million Vermont healthcare claims for approximately 166,000 recipients distributing more than $1.1 billion in Medicaid and other payments to nearly 12,000 healthcare providers.  

Under the agreement HP will:

  • Relocate Vermont’s current MMIS to a state-of-the-art HP data center
  • Upgrade provider call center technology to reduce hold times and dropped calls
  • Enable Vermont to expand its use of the HP Medical Assistance Provider Incentive Repository  tool to track incentive payments to providers under the federal “meaningful use” legislation
  • Continue to provide Vermont with claims processing, financial management, drug rebate processing, system maintenance and modification, plus other provider services, and remediate the current system to be compliant with ICD-10 in support of HIPAA
“The state of Vermont needs to be prepared to adapt to a nationwide healthcare transformation,” said Susan Arthur, Vice President, U.S. Health and Life Sciences Industry, HP Enterprise Services. “The HP team helped develop a powerful and reliable Medicaid infrastructure to enable Vermont to provide care for those in need while maintaining fiscal responsibility.”