An Overview

Vermont Managed Care is a "Physician Hospital Organization" or PHO.  We are a network of physicians and hospitals banded together within a geographic region to coordinate the delivery of healthcare services for a given population, and to be successful in a managed care environment. 

What makes VMC unique is that our Board of Directors is comprised primarily of physicians.  Since the physicians on the VMC Board are clinical representatives of our network, you get a healthcare delivery system governed by, and representative of, its provider participants. The VMC Network has elected to conduct its own care management, allowing a physician-run network to make those difficult day-to-day healthcare decisions for its own patients, rather than an outside third party.  VMC strives to advance care management by maintaining a network educated in managed care principles resulting in the delivery of high quality, effective, and appropriate care.  Our network receives credentialing, data analysis, customer service, provider relations, and financial management services. 

  The Specifics

Vermont Managed Care (VMC) was founded in 1991 to help providers be successful in a managed care environment.  The network has since expanded to include over 2,700 primary and specialty care providers and 10 hospitals in Vermont and New Hampshire.  Some of these providers are linked to VMC through VMC's contracts with PHOs in other regions of Vermont and alliances in New Hampshire.  VMC also has contractual arrangements with other hospitals and health care organizations in Vermont. The network continues to expand as new programs are developed or as clinical need dictates.

VMC is a wholly owned subsidiary of Fletcher Allen Health Care (FAHC) with a separate Board of Directors composed of both FAHC and community-based representatives.  In order to ensure a balance of input, 7 of the 17 board seats are held by community-based representatives.

VMC's main functions are to advance care management efforts by:

* Developing and maintaining a regional network of providers who are oriented to and educated in
   managed care principles.  Providers within the network are assisted in developing the
   necessary tools, processes and systems to maximize value to their members.  The result is the
   delivery of high quality, effective, and appropriate care.
 
* Negotiating, implementing and monitoring managed care contracts with health plans to provide
  comprehensive health care services to members.

VMC provides the following services:

 Care Management:
* Helps providers develop systems to coordinate services throughout the continuum of care
* Utilizes case managers to identify high-risk cases and facilitate development of individualized
   patient care plans. Patients, providers, and payers are included in this process

Contract Management:
* Tracks, monitors, and re-negotiates contract terms including financial reimbursement,
   operational requirements, risk arrangements and clinical management issues

Credentialing:
* Simplifies credentialing with a single process that fulfills all contracted health plan and network
   requirements

Customer Service:
* Resource to providers and members for authorization requirements to include pre-certification 
   and prior approval.
* Maintains eligibility and coordination of benefits for the Fletcher Allen Medical Plans.
* Manages all referrals for VMC Contracted Health Plans.
* Helps resolve claim and billing issues.

Data Analysis:
* Provides data reports to help providers monitor and improve on quality and cost.
* Provides data analysis for providers on ad-hoc basis.

Financial Management:
* Monitors financial performance for VMC contracts and manages monthly financial process and
   reporting.

Provider Relations:
* Negotiates and implements streamlined operational processes across health plans.
* Advocates for the providers and their staff in all payer relations issues.
* Answers provider questions regarding benefit coverage, referral processes, and global
   managed care issues.
* Conducts on-site provider meetings.
* Supports providers with current information needed to be successful in a managed care
   environment.
* Coordinates the network provider enrollment, change, and departure process for all Network
   providers with contracted health plans.

FOR MORE INFORMATION, CLICK ON "ASK VMC", OR PLEASE CALL US AT:
802-847-8161 or 800-639-3881

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