Blueprint Integrated Pilot Programs
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Blueprint Team Vermont Department of Health 108 Cherry Street – Suite 301 PO Box 70 Burlington, VT 05402 Blueprint Integrated Pilot Programs February 2, 2009 Craig Jones, MD Blueprint Executive Director (802) 879-5988 phone (802) 859-3007 fax craig.jones@vdh.state.vt.us Lisa Dulsky Watkins, MD Blueprint Assistant Director (802) 652-2095 phone (802) 859-3007 fax lwatkin@vdh.state.vt.us National Health Policy Conference Washington DC Jenney Samuelson, MS Blueprint Community/Self Management Director (802) 863-7204 phone (802) 859-3007 fax jsamuel@vdh.state.vt.us James Morgan, MSW Blueprint Project Administrator (802) 865-7795 phone (802) 859-3007 fax jmorgan@vdh.state.vt.us Health Care Reform Goals Increase Access Beth Thorpe Blueprint Business Manager (802) 652-2094 phone (802) 859-3007 fax bthorpe@vdh.state.vt.us Terri Price Blueprint Administrative Support Healthier Living Workshop Statewide Coordinator (802) 652-2096 phone (802) 859-3007 fax tprice@vdh.state.vt.us Diane Hawkins Executive Staff Assistant to Craig Jones Office of Health Care Reform 312 Hurricane Lane Williston, VT 05495 (802) 879-5988 diane.hawkins@vdh.state.vt.us Vermont Blueprint Context Improve Quality 60+ Initiatives • 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 Contain Costs Funding Programs • History of working together Products Blueprint Communities (Act 191, 2006) Clinical Transformation Blueprint Integrated Pilot Summary VPQ Coordinated Training Clinical Microsystems Sustainable Transformation Provider Incentives Blueprint / State •Global Commitment •Catamount Fund •Federal Funds •HIT Fund Multi Insurer Reform •Medicaid •BCBS •Cigna •MVP Grant Support ? 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 71 2007, Act 204 2008) 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 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 - Updated EMRs to match program goals and clinical measures in DocSite - Health information exchange network 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 Blueprint Integrated Pilot Model NCQA Scoring & Provider Payment $2.50 $ PPPM per provider Primary Care PCMH -Docs -NPs -PAs -MAs -Staff 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 $3.00 PPPM Payment $2.00 $1.50 CCT Support Panel Management Coaching Patient / family contact Assessment Reinforce treatment plan Education Reminders Self management Referrals, Communication & QI Planning Social / Economic Support Liaison to other programs Enrollment assistance $1.00 Community Care Team (CCT) e.g. NP, RN, MSW, Dietician, Behavior Specialist, Community Health Worker, VDH Public Health Specialist $0.50 5 of 10 MP $0.00 0 10 20 30 Prevention & Self Management Referral to community programs Coordinate community programs 10 of 10 MP 40 50 60 70 80 90 Vermont Health Information Platform (VITL) 100 NCQA PCMH Score Referral & care support Model for Health & Prevention Education & Improvement Community Assessment & Planning Timeline October 2008 Hospital -Educators -Transitional care -Ambulatory center (wellness programs) Referrals & Communication Primary Care PCMH -Docs -NPs -Staff Healthcare Community Care Team (CCT) e.g. NP, RN, MSW, Dietician, Behavior Specialist, Community Health Worker, VDH Public Health Specialist Prevention 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 Policies and Systems 4-6 months 2-4 months Local, state, and federal policies and laws, economic and cultural influences, media 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 3-5 months Community Physical, social and cultural environment PHASE I - Develop capacity •Facilitate systems approach •Train Prevention Specialist •Prevention Model and Framework •Data collection techniques •Environment and policy change 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 15:351-377, 1988. Vermont Health Information Platform (VITL) Referral & care support Education & Quality Improvement Blueprint Integrated Pilots Blueprint Pilot Timeline & Evaluation 07 / 08 10 / 08 01 / 09 07 / 09 10 / 09 Evidence Based Quality Improvement 01 / 2010 07 / 2010 Data Source Pilot # 1 Pilot # 2 EMRs used for Individual Patient Care Data Processing & Storage EMR Databases Data Analysis Data Reports & Uses Data transmission & transformation VITL / GE EMR Reporting Tool or Analyst Clinical Process Measures Individual Patient Care & Support Services DocSite Database DocSite Reporting Tool Health Status Measures Population Management Contracted Analysis Services Healthcare Quality Measures & Standards Quality Improvement Pilot # 3 Category Data Source Evaluation Outline PCMH healthcare process quality •NCQA PCMH Score •VCHIP practice review •NCQA recognition • • Integrated Pilot practices Change from baseline Clinical process measures •DocSite data base •VCHIP Chart Review • • • Integrated Pilot practices Practices delivering routine care Change from baseline & comparison Health status measures •DocSite data base •VCHIP Chart Review • • • Integrated Pilot practices Practices delivering routine care Change from baseline & comparison Episodic vs. Preventive healthcare – claims based measures •VHCURES – multipayer database • • Pilot practices vs non-pilot practices Change from baseline & comparison Healthcare Costs – claims based measures •VHCURES – multipayer database •Financial Impact Model • • • Pilot practices vs non-pilot practices Impact on healthcare costs in Vermont Change from baseline & comparison Population Health Indicators •VDH Health Surveillance databases • • Community risk profiles State level assessments DocSite used for Individual Patient Care Medical Claims from Commercial Insurers & Medicaid BISCHA Multipayer Database BISCHA Reports Healthcare Patterns & Resource Utilization Provider Payment for Quality VCHIP Chart Review & NCQA Scoring VCHIP Databases VCHIP Analysis & Report Generation Healthcare Expenditures & Financial Impact Program Evaluation & Sustainability VDH Health Surveillance Analytic Database VDH Health Surveillance Analyst Population Indicators & Risk Factors Community Prevention Planning Public Health Surveys & Data Collection Public Health Registries & Databases Data Source EMRs used for Individual Patient Care Blueprint Integrated Pilots Blueprint Integrated Pilots Evidence Based Quality Improvement Evidence Based Quality Improvement Data Processing & Storage Data Reports & Uses Data Source Data transmission & transformation VITL / GE EMR Reporting Tool or Analyst Clinical Process Measures Individual Patient Care & Support Services EMRs used for Individual Patient Care DocSite used for Individual Patient Care DocSite Database DocSite Reporting Tool Health Status Measures Population Management Contracted Analysis Services Healthcare Quality Measures & Standards Quality Improvement Medical Claims from Commercial Insurers & Medicaid BISCHA Multipayer BISCHA Reports Healthcare Patterns & Resource Utilization VCHIP Chart Review & NCQA Scoring VCHIP Databases VCHIP Analysis & Report Generation VDH Health VDH Health Surveillance Analyst Public Health Surveys & Data Collection EMR Databases Data Analysis Database Public Health Registries & Databases Surveillance Analytic Database Data Processing & Storage EMR Databases Data Analysis Data Reports & Uses Data transmission & transformation VITL / GE EMR Reporting Tool or Analyst Clinical Process Measures Individual Patient Care & Support Services DocSite used for Individual Patient Care DocSite Database DocSite Reporting Tool Health Status Measures Population Management Contracted Analysis Services Healthcare Quality Measures & Standards Quality Improvement Provider Payment for Quality Medical Claims from Commercial Insurers & Medicaid BISCHA Multipayer Database BISCHA Reports Healthcare Patterns & Resource Utilization Provider Payment for Quality Healthcare Expenditures & Financial Impact Program Evaluation & Sustainability VCHIP Chart Review & NCQA Scoring VCHIP Databases VCHIP Analysis & Report Generation Healthcare Expenditures & Financial Impact Program Evaluation & Sustainability Population Indicators & Risk Factors Community Prevention Planning Public Health Surveys & Data Collection VDH Health Surveillance Analytic Database VDH Health Surveillance Analyst Population Indicators & Risk Factors Community Prevention Planning Public Health Registries & Databases Blueprint Integrated Pilots Evidence Based Quality Improvement Pilot Site Data Source EMRs used for Individual Patient Care Data Processing & Storage EMR Databases DocSite used for Individual Patient Care Data Analysis Data transmission & transformation VITL / GE DocSite Database EMR Reporting Tool or Analyst Data Reports & Uses Clinical Process Measures Individual Patient Care & Support Services DocSite Reporting Tool Health Status Measures Population Management Contracted Analysis Services Healthcare Quality Measures & Standards Quality Improvement BISCHA Multipayer Database BISCHA Reports Healthcare Patterns & Resource Utilization Provider Payment for Quality VCHIP Chart Review & NCQA Scoring VCHIP Databases VCHIP Analysis & Report Generation Healthcare Expenditures & Financial Impact Program Evaluation & Sustainability VDH Health Surveillance Analytic Database VDH Health Surveillance Analyst Population Indicators & Risk Factors Community Prevention Planning Public Health Registries & Databases Blueprint Integrated Pilots Plan for statewide expansion BP Integrated Pilot Experience BP Community Experience Continuous Quality Improvement Shift BP Grant to new community or expand across a community # Patients Caledonia Internal Medicine 3 Concord Health Center 2 2,183 Corner Medical 6 14,500 Danville Health Center 2 3,088 St. Johnsbury Family Health Center 2,011 2 2,822 15 24,604 Fletcher Allen Affiliated Aesculapius Medical Center 9 15,774 Private Practice – Non Affiliated 1 1,800 10 17,574 25 42,178 Pilot # 2 Pilot # 1 Burlington Total Burlington Bennington Planning stages Total (first 2 sites only) Pilot # 3 Blueprint Integrated Pilots Building a Scalable Model Build a model for effective and sustainable reform Continuous Quality Improvement Use experience from Integrated Pilot program to refine & target BP Community grants. Build capacity & readiness for more complete healthcare reform. # Provider Practice Total St Johnsbury Medical Claims from Commercial Insurers & Medicaid Public Health Surveys & Data Collection Community St. Johnsbury Transform from BP Community to Integrated Pilot Community, and/or, expand existing Integrated Pilot to include more Blueprint practices in a community Financial Incentives (balance volume & quality) Environment (PCMH, CCTs, PH specialists, Health IT) Focus (quality, wellness, prevention) Evaluation (multidimensional, routine) Culture (self management, engaging yet objective)
