Vermont officials are traveling to Washington, D.C., to continue negotiations with the federal government for waivers that will allow the state to transform the way healthcare is paid for. Robin Lunge, director of healthcare reform for Gov. Peter Shumlin, said work continues on shifting the state away from an FFS model to one that pays healthcare providers based on health outcomes. Under an all-payer model, which requires a series of waivers from the federal government that the state can apply for under the ACA, healthcare providers would operate under fixed payments. The Green Mountain Care Board would set rates for all payers - Medicaid, Medicare and private insurance. Lunge said state and federal officials must negotiate significant details about the state's request for shifting to an all-payer model. Lunge said Vermont is making significant progress toward an all-payer model, but there are "a number of other states that are at least neck-and-neck." She said Arkansas has been "touted as an example of doing a lot in payment reform." However, much of the focus on Arkansas has been on Medicaid, while Vermont has been focused on all government and private payer.