MONTPELIER -- The state pledged to make 90 percent of health care payments "value-based" within five years, as part of its application for a $45 million state innovation grant.

Anya Rader Wallack, a consultant for the state who leads the team that is allocating the State Innovation Model grant award, said payments to providers must be in some way be tied to quality of care.

Jump-starting payment reform was the reason Vermont applied for the grant, and tying payments to the quality of care is reasonable, she told lawmakers on the House Health Care Committee on Thursday.

"I'm not sure what they're going to do if we don't make good on that pledge," said Anya Rader Wallack, a consultant who leads the team that is allocating the money.

Anya Rader Wallack. (VTDigger photo) (Josh Larkin)

Rep. George Till, D-Jericho, said he was dumbfounded that the administration would make such a pledge.

"In actuality, only a very small portion of the payments received by the practice are based on the quality measures," Till wrote in an email.

Wallack tried to reassure him, explaining that federal regulators' definition of "value-based" payments includes Vermont's payments to primary care providers through the Blueprint for Health.

The majority of Vermont's health care providers have signed up with an Accountable Care Organization, and with Medicaid and commercial insurers beginning to offer shared savings programs to the organizations this year, the state is increasing the opportunity for value-based payments, Wallack said.

Shared savings payment programs are considered value-based because the amount of savings payers give back to the Accountable Care Organization is partially based on how well they do in meeting the payers' quality measures.

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Consultant: Vermont already moving toward 'value-based' health care payments