Transcript Blueprint Integrated Pilot Programs Building an Integrated System of Health Congressional Briefing December 13, 2010 Alliance for Health Reform & Commonwealth Fund Craig Jones, MD Blueprint.

Blueprint Integrated Pilot Programs
Building an Integrated System of Health
Congressional Briefing
December 13, 2010
Alliance for Health Reform & Commonwealth Fund
Craig Jones, MD
Blueprint Executive Director
[email protected]
11/6/2015
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Need reforms that lead to coordinated health services
with a focus on prevention & wellness
Coverage equals Coverage
Coverage does not equal:
Reliable access
High quality health services
Improved patient experience
Better control over healthcare costs
Vermont's Reforms Include:
Universal coverage
Advanced Primary Care foundation (PCMHs + CHTs)
Multi-Insurer Payment Reforms
A statewide health information exchange
An evaluation infrastructure to support ongoing improvement
Facilitators & support for a learning health system
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
Community Health Team
Nurse Coordinator
Social Workers
Nutrition Specialists
Community Health Workers
MCAID Care Coordinators
Public Health Specialist
Mental Health &
Substance Abuse
Programs
community health teams that can
support coordinated care and linkages
with a broad range of services
Medical
Home
Specialty Care & Disease
Management Programs
Social, Economic, &
Community Services
 A foundation of medical homes and
Medical
Home
supports a foundation of medical
homes and community health teams
Medical
Home
Medical
Home
Healthier Living
Workshops
Public Health
Programs & Services
Health IT Framework
 Multi Insurer Payment Reform that
 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
Evaluation Framework
11/6/2015
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Multi-insurer Payment Reforms
•Medicaid
•Commercial Insurers
•Medicare?
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 - $2.49 PPPM
•Based on active case load
•Community Health Teams
•Shared costs as core resource
•Consistent across insurers
•Minimizes barriers
•5 FTE / 20,000 people
•$ 350,000 per 5 FTE
•Scaled based on population
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
State & Federal Partnerships
Building a preventive health services model
Federal Agencies & Programs
CMS
Clinical Models
Financial Reforms
Payment Reforms
 Financial & Payment Reforms
ONC
Health Information Infrastructure
Expand use of Electronic Health Records
 Advanced Primary Care Practices
CDC
Public Health
Prevention
AHRQ
Evaluation
Quality Improvement
Best Practices & Implementation
HRSA
Health Centers
Rural Health
National Health Service & Workforce
National Institutes
Evidence Based Guidelines
Research & Evaluation
IOM
Framework for a Learning Health System
Design Principles & Goals
Systemness in a Non-System
State
Led
Health
Reform
 Care Support
 Coordinated Services
 Guideline Based Care
 Focus on Prevention
 Health Information Infrastructure
 Evaluation & QI Infrastructure
 Learning Health System
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