In October 2016, the State of Vermont signed an unprecedented agreement (The All-Payer Accountable Care Model) with the Federal Government to completely reform how health care is delivered and paid for in Vermont. This innovative agreement builds on sweeping 2011 legislation that set Vermont on a course towards payment reform designed to eliminate the fragmentation, overtreatment, and high costs associated with fee-for-service reimbursement. The strong emphasis on care coordination, preventative care, the patient experience, and population health ensures a crucial and growing role for nurses in this innovative environment and provides a model to inform the nation. Such state-led reform may have particular importance during the Trump administration, given the expected emphasis on state's rights and state leadership.

中文翻译：

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从单层到全层：为什么佛蒙特州的改革努力对美国护士及其患者如此重要。

2016年10月，佛蒙特州与联邦政府签署了史无前例的协议（全薪责任医疗模式），以彻底改革佛蒙特州医疗服务的提供和支付方式。这项具有创新意义的协议以2011年全面立法为基础，使佛蒙特州开始着手进行付款改革，以消除服务费用报销带来的分散性，过度处理和高成本。在这种创新的环境中，对护理协调，预防性护理，患者体验和人群健康的高度重视，确保了护士在这一方面日益重要的作用，并为国家提供了一种典范。鉴于预期将重点放在州的权利和州领导上，这种由州主导的改革在特朗普执政期间可能特别重要。