The Green Mountain Care Board and VMS Education and Research Foundation

1. The Green Mountain Care Boardand VMS Education and Research Foundation Actualizing reform thru clinician leadership Better quality, Better health, Lower costs January 9th, 2014

2. Optimizing hospital care Better care, better health, lower costs How can leaders accelerate innovation? You have to have the willto improve; You have to have ideasabout alternatives to the status quo; and You have to make it real through execution All three have to be arranged by leaders – they are not automatic • A population-based care plan • Anticipation of workforce needs • Coordination of care across settings • Transparency of payment reform • Meaningful actionable measurement

3. Actualizing hospital reform thruclinician leadership Better care, better health, lower costs • Region-wide bed-board triage system • Hospital, rehab and SNF • CMS waivers • Patients located by need, not facility revenue or compliance Five Things Physicians and Patients Should Question Avoid transfusions of red blood cells for arbitrary hemoglobin or hematocrit thresholds and in the absence of symptoms of active coronary disease, heart failure or stroke.

4. Optimizing rural careBetter care, better health, lower costs “Our current clinical capabilities are such that we never lose a life because we are missing capacity when a life threatening situation presents itself; but we are all really stressed ” -Rural health system medical director • Reduce the gap between practice and policy • Actualize 3 planned levels of care • Become the national benchmark for measurement • Make VT a magnet for the workforce

5. Actualizing rural reform thru clinician leadership Better care, better health, lower costs Reduce policy gap “My biggest hope is that reform will work, but my biggest fear is that it will not. There needs to be physician buy in. There needs to be a critical mass of engaged supportive physicians “ primary care physician The Vermont Academy of Family Physicians will be hosting a VMS Foundation conference on Saturday, January 25, 2014 for all VT clinician leaders wanting a say in reform Capitol Plaza Montpelier 8 a.m. – 12 p.m.  Actualizing rural reform • Recommendations for change • 3 focus areas from the Rural Whitepaper: • Measuring things that matter to patients and practices; • Integrating social and community services with clinical services; and • Planned community-based and regionalized clinical services • 3 breakout groups • Broaden and refine clinician input • Discuss recommendations for change to be considered by the GMCB • Plenary session report out and discussion • Written conference summary • 2nd GMCB presentation in February

6. Actualizing VT reform - clinician leadership VT Clinician Leadership Institute (VCLI) VCLI - Business plan Design - Feb 2014 – Sept 2014 Tuition commitments Advisory committee Faculty RFP First class Sept 2014 – June 2015 Funding depends on value Self-sustaining thru tuitions Pooled tuitions – 5 scholarships 80 CMEs (CEUs) MBA credits • 9 month curriculum • 20-30 Fellows each class • Licensed VT clinical practitioners • Leadership awareness/skill building • Management knowledge/skills • Health Policy and Reform – fed/state • Individual leadership projects (MOU) • Network/pipeline of clinician leaders • Workforce engaged in reform

7. Mental health/Substance abuse community of clinician leaders • Clinician leaders with shared interest in reform • Community champion – respected clinician leader • Recruitment of MH/SA clinician leaders • Research design – Actualizing MH/SA Reform • Face to face meetings • Conference calls • Web based resources • Research activity period • Whitepaper - Actualizing MH/SA reform • Fall 2014 GMCB presentation • Recommendations and action steps

8. Actualizing reform thru clinicianleadershipBetter care, better health, lower costs • Hospital reform • Hospital clinician leaders • Region-wide triage system • CMS waivers • Choosing Wisely – Transfusions • Rural reform • Jan 25 Work Session • Broaden leadership input • Develop reform action steps • Reform project(s) with GMCB • Engaged workforce • VCLI • Feb 2014 – Sept 2014 • Design/Commitments • Sept 2014 – June 2015 • Individual reform projects • Pipeline of future leaders • MH/SA reform • MH/SA clinician leaders community • GMCB whitepaper Dec 2015 • Action steps

9. The Green Mountain Care Boardand VMS Education and Research Foundation Actualizing reform thru clinician leadership Better quality, Better health, Lower costs