Vermont Blueprint for Health: Using APCD to Evaluate Health Care Reform

1. Vermont Blueprint for Health:Using APCD to Evaluate Health Care Reform Pat Jones, MS Blueprint Assistant Director Department of Vermont Health Access National APCD Conference October 25, 2012

2. The Vermont Blueprint for Health: • Building A Foundation For The Future • Advanced Primary Care Practices (Patient Centered Medical Homes) • Community Health Teams (core and extended) • Multi-insurer Payment Reforms • Health Information Infrastructure • Evaluation and Reporting Systems • Learning Health System Activities

3. Hospitals • A foundation of medical homes and community health teams that can support coordinated care and linkages with a broad range of services • Multi-insurer payment reform that supports this 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 Advanced Primary Care Specialty Care & Disease Management Programs Community Health Team Nurse Coordinator Social Workers Nutrition Specialists Community Health Workers Public Health Specialist Extended Community Health Team Medicaid Care Coordinators Medicare “Support and Services at Home” Teams Addiction Teams Advanced Primary Care Social, Economic, & Community Services Advanced Primary Care Mental Health & Substance Abuse Programs Advanced Primary Care Healthier Living Workshops Public Health Programs & Services Health IT Framework Evaluation Framework Multi-Insurer Payment Reform Framework

4. Data Sources & Evaluation • Central Clinical Registry • Multi-payer Claims Database • Chart Reviews • NCQA Scoring • Public Health Registries • Patient Provider Qualitative Assessment • Patient Experience

5. How does the Blueprint use VHCURES for evaluation? • Used for evaluation, financial modeling, practice profiles, special studies • Compares Blueprint participants and controls • Expenditure measures (e.g., inpatient, ED, professional, pharmacy, mental health) • Utilization measures (e.g., inpatient discharges, ambulatory care sensitive conditions, readmissions, preventable ED visits, advanced imaging, medical and surgical specialty care) • HEDIS® effective and preventive care measures (e.g., breast cancer screening, well child visits) • Measures are evaluated separately for members with seven targeted chronic conditions (diabetes, asthma, COPD, hypertension, CHF, coronary heart disease, depression)

6. Example of Utilization ReportingSource: Analysis by Onpoint Health Data for 2011 Blueprint Annual Report Outpatient ED Visits Inpatient Discharges

7. Example of Expenditure ReportingSource: Analysis by Onpoint Health Data for 2011 Blueprint Annual Report Outpatient ED Expenditures per Capita Inpatient Expenditures per Capita

8. Practice Profiling TemplateSource: Sample Data from 20 Blueprint Practices Outpatient ED Visits