Vermont Blueprint for Health

1
Vermont Blueprint for Health Integrated Pilot
Programs
PCPCC Call Lisa Dulsky Watkins, MD Vermont
Department of Health January 20, 2009

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Vision
Vermont will have a statewide system of care that
improves the lives of individuals with and at
risk for chronic conditions
3
What is the Blueprint?
Community
Health System
Resources and Policies
Health Care Organization
Public Health Policies, Systems, Environment
ClinicalInformationSystems
Self-Management Support
DeliverySystem Design
Decision Support
Supportive Environment
Prepared, Proactive Practice Team
Informed, Activated Patient
Productive Interactions
Improved Outcomes-Healthier People
Adapted from the chronic care model which is
used by permission of Effective Clinical
Practice.
4
Who are the players?

• State Government
• Executive and Legislative branches
• Department of Health
• Over 100 volunteers serving on committees and
  workgroups
• Insurers publicly and privately funded
• University of Vermont College of Medicine
• Vermont Information Technology Leaders
• Local and national QI organizations
• Vermont Program for Quality in Health Care
• Institute for Healthcare Improvement
• Agency for Healthcare Research and Quality
• AcademyHealth/Commonwealth Fund
• Providers MD, DO, NP, PA, nursing and office
  staff
• Patients and families

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Blueprint Development
Burlington
St. Johnsbury
Barre
Windsor
Springfield
Bennington
2009 - Integrated Medical Home Pilots (all
chronic conditions prevention)
April 2007
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Health Care Reform Legislation

• 2006
• Health Care Affordability Acts (Acts 190, 191)
• Common Sense Initiatives (Appropriations Bill)
• Sorry Works! (Act 142)
• Safe Staffing and Quality Patient Care (Act
  153)
• 2007
• Corrections and Clarifications to the Health Care
  Affordability Acts of 2006 (Act 70)
• An Act relating to Ensuring Success in Health
  Care Reform (Act 71)
• 2008
• An Act Relating to Health Care Reform (Act 203)
• An Act Relating to Managed Care Organizations and
  the Blueprint for Health (S.283)

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Blueprint Integrated Pilot Summary
1. Financial reform - Payment based on NCQA PCMH
standards - Shared costs for Community Care
Teams - Medicaid commercial payers - BP
subsidizing Medicare 2. Multidisciplinary care
support teams (CCT Teams) - Local care support
population management - Prevention
specialists 3. Health Information Technology -
Web based clinical tracking system (DocSite) -
Visit planners population reports -
Electronic prescribing - Updated EMRs to match
program goals and clinical measures in DocSite
- Health information exchange network 4.
Community Activation Prevention - Prevention
specialist as part of CCT - Community profiles
risk assessments - Evidence based
interventions 5. Evaluation - NCQA PCMH score
(process quality) - Clinical process measures -
Health status measures - Multi payer claims data
base
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Blueprint Integrated Pilot Model

• Primary Care PCMH
• Docs
• NPs
• PAs
• MAs
• Staff

• 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

• CCT Support
• Panel Management
• Coaching
• Patient / family contact
• Assessment
• Reinforce treatment plan
• Education
• Reminders
• Self managementSocial / Economic Support
• Liaison to other programs
• Enrollment assistancePrevention Self
  Management
• Referral to community programs
• Coordinate community programs

Referrals, Communication QI Planning
Community Care Team (CCT) e.g. NP, RN, MSW,
Dietician, Behavior Specialist, Community Health
Worker, VDH Public Health Specialist
Vermont Health Information Platform (VITL)
Referral care support
Education Improvement
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Model for Health Prevention
Referrals Communication
Hospital -Educators -Transitional
care -Ambulatory center (wellness programs)

• Primary Care PCMH
• Docs
• NPs
• Staff

Healthcare
Community Care Team (CCT) e.g. NP, RN, MSW,
Dietician, Behavior Specialist, Community Health
Worker, VDH Public Health Specialist
Prevention
Vermont Health Information Platform (VITL)
Referral care support
Education Quality Improvement
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Community Assessment Planning Timeline October
2008

• PHASE 2b - Community Assessment
• Quantitative Context - state level 10 year trend
  analysis of risk factors associated with
  morbidity healthcare costs
• Focus groups
• Formal key leader interviews
• Continue until no new themes
• Test themes in new interviews
• Test findings in community forums

• PHASE 2a - Community Profile
• Community description
• Community inventory
• Quantitative Context - Descriptive health
  statistics on the rates of risk factors
  in each community (5 year aggregate data)

• PHASE 4 - Implementation
• Timeline depends on scope and resources of
  planned intervention

• PHASE 3 - Community Planning
• Planning with key leaders
• Planning with stakeholders
• Iterative interactive process
• Consensus building

Phase 5 Evaluation
3 - 5 months
4 - 6 months
2 - 4 months

• PHASE I - Develop capacity
• Facilitate systems approach
• Train Prevention Specialist
• Prevention Model and Framework
• Data collection techniques
• Environment and policy change

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Pilot 2
Pilot 1
Pilot 3
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Standards
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Provider Payment Table (PPPM for each provider)
Requires 5 of 10 must pass elements
Requires 10 of 10 must pass elements
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Practice Evaluation Quality Improvement

• QI (current)
• Clinical Microsystems Training
• VHR
• DocSite

• Evaluation (current)
• Chart Review
• ACIC (readiness)
• Focus Groups

• Evaluation (integrated pilot)
• Review against NCQA standards
• Onsite Review
• Analysis of DocSite data
• Report based on NCQA scoring

• Evaluation (Integrated pilot)
• Use reports
• Guide Microsystems Training
• Guide QA / QI planning
• Focused on NCQA PCMH Stds

Ongoing QA / QI
Payment
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Practice Evaluation Payment Model
6 months
30 days
30 days
Evaluators Report
Evaluators Report
NCQA Review
NCQA Review

• Adjust Payment
• Retroactive to 6 month interval date
• PPPM calculation -refreshed NCQA score
  -refreshed active patient panel
• Active patient panel (attribution) -visit
  lt12 months to practice PCP -eligibility
  check
• Paid quarterly or Monthly (payer defined)

• Start Payment
• Retroactive to index date
• PPPM calculation -initial NCQA score
  -active patient panel
• Active patient panel (attribution) -visit
  lt12 months to practice PCP -eligibility
  check
• Paid quarterly or Monthly (payer defined)

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Blueprint Pilot Timeline Evaluation
01 / 09
01 / 2010
07 / 08
10 / 08
07 / 09
10 / 09
07 / 2010
Pilot 1
Pilot 2
Pilot 3
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Blueprint Integrated Pilots Evidence Based
Quality Improvement
Data Processing Storage
Data Source
Data Analysis
Data Reports Uses
Clinical Process Measures
Individual Patient Care Support Services
EMRs used for Individual Patient Care
EMR Databases
Data transmission transformation VITL / GE
EMR Reporting Tool or Analyst
Health Status Measures
Population Management
DocSite used for Individual Patient Care
DocSite Database
DocSite Reporting Tool
Healthcare Quality Measures Standards
Quality Improvement
Contracted Analysis Services
Medical Claims from Commercial Insurers Medicaid
Healthcare Patterns Resource Utilization
Provider Payment for Quality
BISCHA Multipayer Database
BISCHA Reports
Healthcare Expenditures Financial Impact
Program Evaluation Sustainability
VCHIP Chart Review NCQA Scoring
VCHIP Analysis Report Generation
VCHIP Databases
Population Indicators Risk Factors
Community Prevention Planning
Public Health Surveys Data Collection
Public Health Registries Databases
VDH Health Surveillance Analytic Database
VDH Health Surveillance Analyst
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Blueprint Integrated Pilots Evidence Based
Quality Improvement
Data Processing Storage
Data Source
Data Analysis
Data Reports Uses
Individual Patient Care Support Services
EMRs used for Individual Patient Care
EMR Databases
Data transmission transformation VITL / GE
EMR Reporting Tool or Analyst
Clinical Process Measures
Population Management
DocSite used for Individual Patient Care
DocSite Database
DocSite Reporting Tool
Health Status Measures
Quality Improvement
Contracted Analysis Services
Healthcare Quality Measures Standards
Medical Claims from Commercial Insurers Medicaid
BISCHA Multipayer Database
BISCHA Reports
Healthcare Patterns Resource Utilization
Provider Payment for Quality
Program Evaluation Sustainability
VCHIP Chart Review NCQA Scoring
VCHIP Analysis Report Generation
Healthcare Expenditures Financial Impact
VCHIP Databases
Public Health Surveys Data Collection
Public Health Registries Databases
VDH Health Surveillance Analytic Database
VDH Health Surveillance Analyst
Population Indicators Risk Factors
Community Prevention Planning
19
Blueprint Integrated Pilots Evidence Based
Quality Improvement
Data Processing Storage
Data Source
Data Analysis
Data Reports Uses
EMRs used for Individual Patient Care
EMR Databases
Data transmission transformation VITL / GE
EMR Reporting Tool or Analyst
Clinical Process Measures
Individual Patient Care Support Services
DocSite used for Individual Patient Care
DocSite Database
DocSite Reporting Tool
Population Management
Health Status Measures
Contracted Analysis Services
Quality Improvement
Healthcare Quality Measures Standards
Medical Claims from Commercial Insurers Medicaid
BISCHA Multipayer Database
BISCHA Reports
Healthcare Patterns Resource Utilization
Provider Payment for Quality
Program Evaluation Sustainability
VCHIP Chart Review NCQA Scoring
VCHIP Analysis Report Generation
Healthcare Expenditures Financial Impact
VCHIP Databases
Public Health Surveys Data Collection
Public Health Registries Databases
VDH Health Surveillance Analytic Database
VDH Health Surveillance Analyst
Population Indicators Risk Factors
Community Prevention Planning
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Blueprint Integrated Pilots Financial Impact
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Blueprint Integrated Pilots Plan for statewide
expansion
BP Integrated Pilot Experience Continuous Qualit
y Improvement
Use experience from Integrated Pilot program to
refine target BP Community grants. Build
capacity readiness for more complete healthcare
reform.
Transform from BP Community to Integrated Pilot
Community, and/or, expand existing Integrated
Pilot to include more Blueprint practices in a
community
BP Community Experience Continuous Quality Impro
vement
Shift BP Grant to new community or expand across
a community
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Blueprint Integrated Pilots Building a Scalable
Model

• Build a model for effective and sustainable
  healthcare reform
• Multi payer financial reform (from volume to
  quality)
• Healthcare environment (PCMH, CCTs, PH
  specialists, Health IT)
• Healthcare focus (from sick care to wellness /
  prevention)
• Healthcare culture (evidence based QI)

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Contact Information

• Lisa Dulsky Watkins, MD
• Assistant Director
• Vermont Blueprint for Health
• Vermont Department of Health
• Burlington, VT
• lwatkin_at_vdh.state.vt.us
• [phone]