Blueprint Integrated Pilot Programs Building an Integrated System of Health

1. 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 craig.jones@ahs.state.vt.us

2. 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

3. 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

4. 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

5. 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 a 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 Medical Home Specialty Care & Disease Management Programs Community Health Team Nurse Coordinator Social Workers Nutrition Specialists Community Health Workers MCAID Care Coordinators Public Health Specialist Medical Home Social, Economic, & Community Services Medical Home Mental Health & Substance Abuse Programs Medical Home Healthier Living Workshops Public Health Programs & Services Health IT Framework Evaluation Framework

6. 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 • Community Health Teams • Shared costs as core resource • Consistent across insurers • Minimizes barriers + + • Based on NCQA PPC-PCMH Score • $1.20 - $2.49 PPPM • Based on active case load • 5 FTE / 20,000 people • $ 350,000 per 5 FTE • Scaled based on population

7. Building a Learning Health System • State • Policy & leadership • Strategic planning • Coordination • IT Infrastructure • Central Registry • Multi-payer database • University of Vermont • NCQA scoring • Chart review • Analytics • Reporting • Informatics platform • Multi-disciplinary expertise Web based reporting platforms Multi-disciplinary study teams Comparative effectiveness & evaluation Coaching & Facilitation Team (Blueprint & University of Vermont) Practices Community Health Teams Hospitals Other Services & Providers

9. State & Federal Partnerships Building a preventive health services model • Systemness in a Non-System • Financial & Payment Reforms • Advanced Primary Care Practices • Care Support • Coordinated Services • Guideline Based Care • Focus on Prevention • Health Information Infrastructure • Evaluation & QI Infrastructure • Learning Health System State Led Health Reform 9