Transcript Slide 1

Vermont Blueprint for Health
Craig Jones, M.D.
Blueprint Executive Director
Burlington, VT
[email protected]
7/16/2015
Vermont Blueprint Context
 Dedicated leadership
 Guiding Legislation
 History of working together
 Improve quality & control of
costs
 Focus on prevention & wellness
 13 Hospitals & Service Areas
 3 major commercial insurers,
Medicaid, Medicare
Hospitals
 A foundation of medical homes and
Advanced
Primary
Care
Specialty Care & Disease
Management Programs
Community Health Team
Nurse Coordinator
Social Workers
Nutrition Specialists
Community Health Workers
MCAID Care Coordinators
Public Health Specialist
Social, Economic, &
Community Services
Mental Health &
Substance Abuse
Programs
Advanced
Primary
Care
Advanced
Primary
Care
Healthier Living
Workshops
Public Health
Programs & Services
Health IT Framework
Evaluation Framework
7/16/2015
Advanced
Primary
Care
community health teams that can
support coordinated care and linkages
with a broad range of services
 Multi Insurer Payment Reform that
supports a foundation of medical
homes and community health teams
 A health information infrastructure
that includes EMRs, hospital data
sources, a health information
exchange network, and a centralized
registry
 An evaluation infrastructure that uses
routinely collected data to support
services, guide quality improvement,
and determine program impact
Multi-insurer Payment Reforms
Insurers
•Fee for Service
•Unchanged
•Allows competition
•Promotes volume
+
•Patient Centered Medical Home
•Payment to practices
•Consistent across insurers
•Promotes quality
+
•Based on NCQA PPC-PCMH Score
•$1.20 - $2.49 PPPM
•Based on active case load
•Medicaid
•Commercial Insurers
•Medicare?
•Community Health Teams
•Shared costs as core resource
•Consistent across insurers
•Minimizes barriers
•5 FTE / 20,000 people
•$ 350,000 per 5 FTE
•Scaled based on population
Data Sources
Categories of Measures
Reporting
Central Registry
Clinical Processes
Health Status
Web based
Flexible & dynamic
Multi-Payer Claims Database
Resource Utilization
Expenditures
Standard Reports
Web based
Flexible & dynamic
Chart Reviews
Clinical Processes
Health Status
Standard Reports
NCQA Scoring
Clinical Processes
PCMH Standards
Standard Reports
Public Health Registries
Population level
Risk Factors
Guide planning
Track change
Standard Reports
IMPACT OF INTEGRATED HEALTH SYSTEMPOTENTIAL COST AVOIDANCE ACROSS TOTAL POPULATION
ANNUAL CHANGE IN
HEALTHCARE EXPENDITURES
$450,000,000
$400,000,000
INCREMENTAL EXPENDITURES
WITHOUT INTEGRATED HEALTH
SYSTEM
28.7%
$350,000,000
INCREMENTAL EXPENDITURES
WITH INTEGRATED HEALTH
SYSTEM
$300,000,000
$250,000,000
$200,000,000
1
2
3
4
5
508,17
80%
25
637,130
100%
32
YEARS
Target Population
% of VT Population
# CHTs
42,179
6.7%
2
126,286 316,662
20%
50%
6
16
Building a Learning Health System
State
• Policy & leadership
Web based reporting platforms
• Strategic planning
Multi-disciplinary study teams
• Coordination
Comparative effectiveness & evaluation
• IT Infrastructure
• Central Registry
• Multi-payer database
University of Vermont
• NCQA scoring
• Chart review
• Analytics
• Reporting
• Informatics platform
• Multi-disciplinary expertise
Coaching & Facilitation Team (Blueprint & University of Vermont)
Practices
Community
Health
Teams
Hospitals
Other Services
& Providers