Transcript Slide 1

Blueprint Integrated Pilot Programs
Funding
Programs
Products
Blueprint Communities
(Act 191, 2006)
Sustainable Transformation
 Clinical Transformation
Blueprint Budget
•Global Commitment
•Catamount Fund
•Federal Funds
Payer Support
•Medicaid
•BCBS
•Cigna
•MVP
Grant Support
VPQ Coordinated Training
Clinical Microsystems
 Provider Incentives
Participation & Training
 Community Activation
Local Programs
 Self Management
Healthier Living Workshops
 Health Information Technology
VPQ Hosted Registry (VHR)
 Evaluation
VPQ Registry Reports
VCHIP Chart Review
 VITL Health Information Exchange Network
Blueprint Medical Home Pilots
(Act 71, 2007)
 Local Care Support
CCT
 Financial Reform
CCT support
Provider Payment
 Prevention
Public Health Specialist on CCT
Local Prevention Team
 Health Information Technology
VITL EMR Pilot Project
VPQ Hosted Web Based CIS with eRx
 VITL Health Information Exchange Network
Evaluation Infrastructure
 Multi payer claims data base
 Clinical / demographic data base
 Integrated data base
 Peer Review Process
 Improved Care Delivery (Diabetes)
 IT enhanced care (Diabetes)
 Improved self mgmt (HLW attendees)
 Local exercise / prevention programs
 VHR - Descriptive statistics (Diabetes)
 VCHIP – Chart review
 Advanced Medical Home
 Improved Care Delivery (General)
 Local care support & DM services
 Sustainable Financial Reform
 Improved Self Mgmt (Multi-faceted)
 IT enhanced care
-Chronic disease
-Health maintenance
-eRx
 Prevention & Wellness Programs
-Community team
-Evidence based
-Linked with care delivery
 Evidence based healthcare process
 Routine QA / QI
 Evaluation of health impact
 Evaluation of cost of care impact
 Predictive modeling (claims / clinical)
 Epidemiologic / outcomes research
 CCT Utilization Patterns
Model for Health & Prevention
PCMH
Payment reform
Comprehensive guideline based care
Health maintenance & prevention
Chronic conditions
Panel management
Coaching
Reminders
Goal setting
Health IT – planned visits
Health IT – population management
Health IT – eRx
Paper based or EMR practices
Primary Care PCMH
-Docs
-NPs
-PAs
-Staff
Referrals,
Communication
& QI Planning
Community Care Team (CCT)
e.g. NP, RN, MSW, Dietician,
Behavior Specialist, Community
Health Worker, VDH Public
Health Specialist
CCT Support
Panel Management
Coaching
Patient / family contact
Assessment
Reinforce treatment plan
Education
Reminders
Self management
Social / Economic Support
Liaison to other programs
Enrollment assistance
Prevention & Self Management
Referral to community programs
Coordinate community programs
Vermont Health Information Platform (VITL)
Referral & care support
Education & Improvement
Public Health & Prevention
Model for Health & Prevention
Key points – BP plan to expand use of HIT
 DocSite: Individualized visit planner (health maintenance & chronic disease)
 DocSite: Sophisticated reporting that supports population management
 DocSite: Electronic prescribing
 DocSite: Works with an EMR or as stand alone care support system
 EMRs:
Broader scope of functionality (at the individual patient level!!!)
 EMRs & DocSite have COMPLIMENTARY clinical functions
 Registries such as DocSite can be an extension of an EMR (a module)
 HIE should support the FULL RANGE of clinical scenarios
 Practices and providers will adapt to best fit
Model for Health & Prevention
Examples of how clinical work flow can vary
- supported by complimentary health IT products
1. All practice & CCT personnel use EMR for all data entry and care support
(1 way data exchange to DocSite - data to be used to evaluate program)
2. Practice & CCT personnel use EMR for all data entry and use DocSite for
population reports (Requires 1 way data exchange to DocSite)
3. Practice personnel use EMR for all data entry. CCT uses DocSIte for data entry
and population reports (2 way data exchange)
4. Practice personnel use EMR for all data entry and use DocSite visit planner to
help guide visit. CCT uses DocSIte for data entry and population reports
(2 way data exchange)
5. Most practice personnel use EMR for data entry. The staff that are doing the
intake assessment use survey and risk assessments in DocSite, enter vital signs
in DocSite, and generate visit planner (2 way data exchange)
Model for Health & Prevention
Hospital
-Educators
-Transitional care
-Ambulatory center
(wellness programs)
Primary Care PCMH
-Docs
-NPs
-Staff
Referrals &
Communication
Community Care Team (CCT)
e.g. NP, RN, MSW, Dietician,
Behavior Specialist,
Community Health Worker,
VDH Public Health Specialist
Policies and Systems
Local, state, and federal policies and laws,
economic and cultural influences, media
Community
Physical, social and cultural
environment
Organizations
Schools, worksites, faith-based
organizations, etc
Relationships
Family, peers, social networks, associations
Individual
Support for evidence based
public health, prevention, &
policy
Knowledge, attitudes,
beliefs
Adapted from: McElroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Education
Quarterly 15:351-377, 1988.
Vermont Health Information Platform (VITL)
Referral & care support
Education & Improvement
Public Health & Prevention
St. Johnsbury Family HC
Chronic Care Coor .5 FTE
Beh. Health Spec. .5 FTE
Primary Care Practices
VDH District Office
Public Health Specialist
Ladies First Coordinator.
Calodenia Int. Medicine
Chronic Care Cood .5 FTE
Beh. Health Spec. .5 FTE
Concord Health Ctr.
Chronic Care Cood .5 FTE
Beh. Health Spec. .5 FTE
Danville Health Center
Chronic Care Coor .5 FTE
Beh. Health Spec .5 FTE
Corner Medical
Chronic Care Coor 1 FTE
Beh. Health Spec 1 FTE
St. Johnsbury
Community Care Team
Community Connections
Community Health Workers
CC Comm. Health Worker
Other
OVHA Care Managers
Hospital Care Managers
Hospital-based CC Educators
Community-based Advocates
Data Management-Analysis-Reporting
Clinical Site / Organization
Clinical Site / Organization
Clinical Site / Organization
BAA
Clinical Site / Organization
BAA
Clinical Site / Organization
BAA
BAA
Payer Data
 Stratification
 Cohort comparisons
 Payment information
Other organizations
• Submit request
• Peer review approval
• Receive de-identified data, reports
BAA
VITL
BAA
BAA
GE hosted Central
Data Repository
BA
External
Recognized
IRB Entity
Data Management
Routine data flow & reporting
Clinical data flow across organizations
Request for data use
Custom reports & data transfer
BLUEPRINT PILOT PROGRAM
Plan For Program Evaluation & Improvement
Objective
Performance
Measure
Relevant to objective
Analysis & Review
Achieve objective?
Modify of Healthcare Process
Modify Measures & Methods
The Patient Centered Medical Home is a health care setting that facilitates
partnerships between individual patients, and their personal physicians, and
when appropriate, the patient’s family. Care is facilitated by registries,
information technology, health information exchange and other means to
assure that patients get the indicated care when and where they need and
want it in a culturally and linguistically appropriate manner.
There are nine PPC standards, including 10 must pass elements, which can
result in one of three levels of recognition. Practices seeking PPC- PCMH
complete a Web-based data collection tool and provide documentation that
validates responses.
Standards
NCQA PCMH Scoring
NCQA Level
Points
Must Pass
0
Level 1
Level 2
Level 3
0-24 NR
25-49
50-74
75-100
<5
5 of 10
10 of 10
10 of 10
NR
20
40
60
80
100
Proposed Model for Provider Payment
NCQA Level
Points
Must Pass
0
Level 1
Level 2
Level 3
0-24 NR
25-49
50-74
75-100
<5
5 of 10
10 of 10
10 of 10
NR
20
40
60
80
All PC Providers
Start Payment
Adjust Payment
(Range 25 – 100 PCMH Points)
Potential Range of Payment
$ 1.20 PPPM
At 25 points and
5 of 10 MP elements
.08 / PPPM / unit
1 unit = 5 NCQA Points
Requires 10 of 10 MP
criteria > 50 points
$1.20 – $2.39 PPPM
100
Provider Payment Table
($PPPM for each provider)
Requires 5 of 10 must pass elements
Requires 10 of 10 must pass elements
NCQA PCMH
Points
Average
Payment
0
0.00
5
0.00
10
0.00
15
0.00
20
0.00
25
1.20
30
1.28
35
1.36
40
1.44
45
1.52
50
1.60
55
1.68
60
1.76
65
1.84
70
1.92
75
2.00
80
2.07
85
2.15
90
2.23
95
2.31
100
2.39
NCQA Scoring & Provider Payment
$ PPPM per provider
3.00
1-3 Providers
4+ providers
2.50
Modified Average
2.00
1.50
1.00
0.50
0.00
0
10
20
5 of 10 MP
30
40
50
60
NCQA PCMH Score
10 of 10 MP
70
80
90
100
Practice Evaluation & Quality Improvement
VPQ (current)
 Clinical Microsystems Training
 VHR
 DocSite
VCHIP (current)
 Chart Review
 ACIC (readiness)
 Focus Groups
VPQ (proposed)
 Use reports
 Guide Microsystems Training
 Guide QA / QI planning
 Focused on NCQA PCMH Stds
VCHIP (proposed)
 Review against NCQA standards
 Onsite Review
 Analysis of DocSite data
 Report based on NCQA scoring
Ongoing QA / QI
Payment
Practice Evaluation & Payment Model
6 months
30
days
VCHIP
Report
NCQA
Review
Start Payment
Retroactive to index date
$ PPPM calculation
-initial NCQA score
-active patient panel
Active patient panel (attribution)
-visit <12 months to practice PCP
-eligibility check
Paid quarterly vs. monthly
30
days
VCHIP
Report
NCQA
Review
Adjust Payment
Retroactive to 6 month interval date
$ PPPM calculation
-refreshed NCQA score
-refreshed active patient panel
Active patient panel (attribution)
-visit <12 months to practice PCP
-eligibility check
Paid quarterly vs. monthly