Blueprint Integrated Pilot Programs
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1 Blueprint Integrated Pilot Programs Improving Access Improving Quality Improving Efficiency National Conference of State Legislatures December 10, 2008 Craig Jones MD
2 Health Care Reform Goals Increase Access Improve Quality 60+ Initiatives Contain Costs
3 Vermont Blueprint Context Relatively good distribution of Primary Care Providers (PCPs) statewide 800 PCPs in 300 practices in 13 Hospital Service Areas Three major health plan carriers + Medicaid + Medicare Most PCPs participate in all plans History of working together
4 Funding Programs Products Blueprint Communities (Act 191, 2006) Sustainable Transformation Blueprint / State Global Commitment Catamount Fund Federal Funds HIT Fund Payer Support Medicaid BCBS Cigna MVP Grant Support? Clinical Transformation VPQ Coordinated Training Clinical Microsystems Provider Incentives Participation & Training Community Activation Local Programs Self Management Healthier Living Workshops Health Information Technology VPQ Hosted Registry (VHR) Evaluation VPQ Registry Reports VCHIP Chart Review VITL Health Information Exchange Network Blueprint Integrated Pilots (Act , Act ) Financial Reform Enhanced provider payment Shared costs for CCT Local Care Support CCT as shared resource Prevention Public Health Specialist on CCT Local Prevention Team Health Information Technology VITL EMR Pilot Project VPQ Hosted Web Based CIS with erx VITL Health Information Exchange Network Evaluation Infrastructure Multi payer claims data base Clinical / demographic data base VCHIP NCQA PCMH scoring VCHIP chart review Improved Care Delivery (Diabetes) IT enhanced care (Diabetes) Improved self mgmt (HLW attendees) Local exercise / prevention programs VHR - Descriptive statistics (Diabetes) VCHIP Chart review Advanced Medical Home Improved Care Delivery (General) Local care support & DM services Sustainable Financial Reform Improved Self Mgmt (Multi-faceted) IT enhanced care -Chronic disease -Health maintenance -erx Prevention & Wellness Programs -Community team -Evidence based -Linked with care delivery Evidence based healthcare process Routine QA / QI Evaluation of health impact Evaluation of financial impact Predictive modeling (claims / clinical) Epidemiologic / outcomes research CCT Utilization Patterns
5 BP Pilot Healthcare transformation. 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 - Health information exchange network (*Health IT Fund) 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
6 Model for Health & Prevention 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 Primary Care PCMH -Docs -NPs -PAs -Staff Referrals, Communication & QI Planning Community Care Team (CCT) e.g. NP, RN, MSW, Dietician, Behavior Specialist, Community Health Worker, VDH Public Health Specialist CCT Support Panel Management Coaching Patient / family contact Assessment Reinforce treatment plan Education Reminders Self management Social / Economic Support Liaison to other programs Enrollment assistance Prevention & Self Management Referral to community programs Coordinate community programs Vermont Health Information Platform (VITL) Referral & care support Education & Improvement Public Health & Prevention
7 Model for Health & Prevention Health Information Environment Data Transmission Plot Site # 1 NVRH EMR System NCHCs EMR System Plot Site # 2 Fletcher Allen Data Warehouse VITL / GE Health Information Exchange Infrastructure Core DocSite Data Elements Core DocSite Data Elements Core DocSite Data Elements DocSite Web Based Health Information System Visit Planners Individual Patient Care Reporting Function Population Management Electronic Rx Evaluation - health process - health outcomes - prevention - epidemiology
8 Model for Health & Prevention Health Information Environment Clinical Operations 1. Providers & Community Care Teams can adapt the use of health information technology that meets their needs 2. Sites with updated EMR likely to use their system for individual patient care 3. Sites with EMR can use DocSite for report generation and population management if reporting functions are superior and easier to use than those in their EMR 4. Sites without an EMR will be able to use DocSite to support individual patient care as well as population management 5. DocSite database supports evaluation of clinical process & health status measures (common data elements from all sites)
9 Community Assessment & Planning Timeline October 2008 PHASE 2a - Community Profile PHASE 2b - Community Assessment Community description Community inventory Quantitative Context - Descriptive health statistics on the rates of risk factors in each community (5 year aggregate data) 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 3 - Community Planning Planning with key leaders Planning with stakeholders Iterative interactive process Consensus building PHASE 4 - Implementation Timeline depends on scope and resources of planned intervention Phase 5 Evaluation 2-4 months 4-6 months 3-5 months PHASE I - Develop capacity Facilitate systems approach Train Prevention Specialist Prevention Model and Framework Data collection techniques Environment and policy change
10 Referral & care support Education & Quality Improvement Model for Health & Prevention Hospital -Educators -Transitional care -Ambulatory center (wellness programs) Primary Care PCMH -Docs -NPs -Staff Referrals & Communication Healthcare Prevention Community Care Team (CCT) e.g. NP, RN, MSW, Dietician, Behavior Specialist, Community Health Worker, VDH Public Health Specialist Policies and Systems Local, state, and federal policies and laws, economic and cultural influences, media Community Physical, social and cultural environment Organizations Schools, worksites, faith-based organizations, etc Relationships Family, peers, social networks, associations Individual Knowledge, attitudes, beliefs Adapted from: McElroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Education Quarterly 15: , Vermont Health Information Platform (VITL)
11 Blueprint Pilot Timeline & Evaluation 07 / / / / / / / 2010 Pilot # 1 Pilot # 2 Pilot # 3 Category Data Source Evaluation Outline PCMH healthcare process quality Clinical process measures Health status measures Episodic vs. Preventive healthcare claims based measures Healthcare Costs claims based measures NCQA PCMH Score VCHIP practice review NCQA recognition DocSite data base VCHIP Chart Review DocSite data base VCHIP Chart Review VHCURES multipay er database VHCURES multipay er database Financial Impact Model Pilot practices Change from baseline Pilot practices Practices in BP communities delivering routine care Change from baseline & comparison Pilot practices Practices in BP communities delivering routine care Change from baseline & comparison Pilot practices vs non-pilot practices Change from baseline & comparison Pilot practices vs non-pilot practices Impact on healthcare costs in Vermont Change from baseline & comparison
12 Public Health Health IT Providers Hospitals Every dollar of health care spending is a dollar of income to someone Three Inconvenient Truths about Health Care. Fuchs NEJM ;17:1749 Benefits Managers Contracted Services Pharmaceutical Companies Insurers
13 Even silos can have systemness
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