Vermont is developing a health care system that could offer a unique opportunity to test a new model for improving population health. Four lines of development converged for the system: 1) a published challenge to create a pay-for-population health system; 2) comprehensive state health reform legislation; 3) the Institute for Healthcare Improvement Triple Aim project; and 4) the concept of the accountable care organization (ACO). In phase 1 of pilot testing, three communities serving 10 percent of the population are using the system, which is based on the enhanced medical home model. Planning is under way for phase 2 of the pilot, ACOs that use incentives based on the Triple Aim goals. Vermont has created a conceptual framework for a community health system and identified some of the practical issues involved in implementing this framework.

This article is part of a special supplement of Preventing Chronic Disease: Public Health Research, Practice, and Policy and summarizes the design and implementation of the enhanced medical home pilots and the results of a feasibility study for the ACO pilots. It describes how one state is using a systematic approach to health care reform to overcome some of the implementation barriers to a pay-for-population health system. Vermont will continue to provide a statewide laboratory for a pay-for-population health system.