Sharon Moffatt RN MSN Acting Commissioner of Health November 6, 2006

1. Sharon Moffatt RN MSN Acting Commissioner of Health November 6, 2006

2. The Vermont Blueprint for Health… • … gives people with chronic conditions the information, tools and encouragement they need to be successfully to manage their health

3. Why is change needed? • Growing health care costs • Vermont health care costs  11.5% • from 2001 • Vermont Medicaid expenditures 13.4 % • since 1997 • All insurers expenditures  9.2% • since 1997

4. Cost of Chronic Conditions is both Personal and Financial Care for people with chronic conditions accounts for: 83% of health care spending 81% of hospital admissions 76% of all physician visits 91% of all prescriptions filled

5. Vermonters with Chronic Disease

7. The Cost of Obesity • One-third of total direct health care costs in the U.S. are related to • 15 Diseases Associated with Obesity • Medical expenses attributable to • Adult Obesity inVermont • 141 Million Annually

8. Vermont Obesity Trends • 53% of Vermont Adults are • obese or overweight OR 226,615 Vermonters are above a healthy weight

9. Reducingdiabetes deaths: options Deaths Per Thousand Adults 2.50 No Change Better Care 2.25 Obesity Prevention 2.00 1.75 1.50 1.25 1980 1990 2000 2010 2020 2030 2040 2050 Time (Year)

10. 2.50 2.25 2.00 1.75 1.50 1.25 Reducing diabetes deaths: comprehensive approach No Change No major changes – status quo Obesity Prevention and Better Care Care and reduction in caloric intake 1980 1990 2000 2010 2020 2030 2040 2050 Time (Year) Deaths from complications–per thousand Adults

11. Vermont Blueprint • A system of care that enables Vermonters to lead healthier lives • A system of care that is financially sustainable • inable;and, • A public-private partnership • that sustains • the new system of care

12. The Chronic Care Model

13. Social Ecological Model Public Policy • Behavior change influenced at all levels Community Organizational Interpersonal Individual

14. Blueprint Partnership Vermont Blueprint Model for Health Community Public Policy Public Health • Built Environment • Health Services • Health Awareness • Healthy Options • Information • Systems Patients and Families Healthy Vermonters • Policies • Infrastructure • Financing • Resources • Advocacy • Regulation • Information • Systems • Health • knowledge • Self-manage- • ment skills • Supportive • home • environment • Information • Systems Health Systems • System policy • Quality care • Reimbursement • Financing • Continuity • Coordination • Information • Systems Health Provider Team • Practice standards • Office Systems • Support • Information • Systems

15. Self Management Healthy Living Workshops

16. Community

17. Blueprint Budget 2006 By Focus Area

18. Self Management • 6 Master Trainers • 45 Instructors • 200 participants • (200 more by 6/30) • 15 towns • 5 VDH staff • Community Services • 5 Communities • 10 District offices • 18 towns-physical activity • VT-211 in 2 pilot communities • 28 VDH staff participate Blueprint for Health—FY 06 • Information • Systems • VHR to practices • Registry Selected • Practice needs • Analysis • 4 VDH staff • Provider Practice • Pilots: • 19 Practices • 45 Providers • 1200 patients • Others: 20 practices • 1VDH staff (PT) • Health Systems • Disease Management • Report • Pay 4 Performance • (study started) • 1 VDH staff (PT)

19. Healthy Living ParticipantsMedical Care Both visits to a doctor’s office and visits to the ED went down significantly at six and 12 months MD Visits ED Visits

20. Daily Activities • For many participants, after 12 months, their health condition does not interfere with their daily activities such as social activities with friends, hobbies, recreational activities and household chores.

21. Physical Activities And Abilities • There is an increase in the number of participants who are able to walk at least 30-60 minutes a week. • Many report having no difficulty walking outdoors, dressing themselves, and picking up clothes from the floor

22. Resources/References • The Chronic Care Model: Improving chronic illness care a national program of The Robert Wood Johnson Foundation, www.improvingchroniccare.org • Wagner, E.H. Chronic Disease Management: What will it take to improve care for chronic illness? Effective Clinical Practice 1998; • 12-4.

23. Resources/References • The Model for Improvement by the Institute for Health Improvement www.ihi.org • The Quality of Health Care Delivered to Adults in the United States. New England Journal of Medicine 2003, 348:26.

24. Best Practice Guidelines • Agency for Healthcare Research and Quality www.guidelines.gov • Institute for Clinical Systems Integration www.icsi.org • American Diabetes Association www.diabetes.org • American Heart Association www.americanheart.org

25. Vermont Blueprint for Health • www.healthvermont.gov