Sharon Moffatt RN MSN
Acting Commissioner of Health
November 6, 2006
The Vermont Department of Health
The Vermont Blueprint for Health…
… gives people with chronic
conditions the information, tools
and encouragement they need to
be successfully to manage their
health
The Vermont Department of Health
Why is change needed?
Growing health care costs
Vermont health care costs
from 2001
 11.5%
Vermont Medicaid expenditures 13.4 %
since 1997
All insurers expenditures
since 1997
 9.2%
The Vermont Department of Health
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
The Vermont Department of Health
Vermonters with Chronic Disease
Percent of Vermont Adults
with Chronic Diseases
2001
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
None
1 or more
2 or more
all ages
65+
3 or more
4 or more
The Vermont Department of Health
The Vermont Department of Health
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 in Vermont
141 Million Annually
The Vermont Department of Health
Vermont Obesity Trends
53% of Vermont Adults are
obese or overweight
OR
226,615 Vermonters are
above
a healthy weight
The Vermont Department of Health
Reducing diabetes deaths: options
Deaths Per Thousand Adults
2.50
No Change
2.25
Better Care
2.00
Obesity
Prevention
1.75
1.50
1.25
1980
1990
2000
2010
Time (Year)
2020
2030
2040
2050
The Vermont Department of Health
Reducing diabetes deaths: comprehensive approach
2.50
No Change
No major changes –
status quo
2.25
2.00
1.75
Obesity
Care and
Prevention
reduction
and Better Care
in caloric intake
1.50
1.25
1980
1990
2000
2010
2020
2030
2040
2050
Time (Year)
Deaths from complications–per thousand Adults
The Vermont Department of Health
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
The Vermont Department of Health
The Chronic Care Model
System of Care
Community
Resources and Policies
SelfManagement
Support
Informed,
Activated
Patient
Health System
Organization of Health Care
Delivery
System
Design
Productive
Interactions
Decision
Support
Clinical
Information
Systems
Prepared,
Proactive
Practice Team
Functional and Clinical Outcomes
The Vermont Department of Health
Social Ecological Model
Public Policy
Behavior change
influenced at all
levels
Community
Organizational
Interpersonal
Individual
Vermont Blueprint Model for Health
The Vermont Department of Health
Blueprint Partnership
Public Policy
Public Health
•Policies
•Infrastructure
•Financing
•Resources
•Advocacy
Health
•Regulation
Systems
•Information
Systems
•System policy
•Quality care
•Reimbursement
•Financing
•Continuity
•Coordination
•Information
Systems
Community
•Built Environment
•Health Services
•Health Awareness
•Healthy Options
•Information
Systems
Health
Provider Team
•Practice standards
•Office Systems
•Support
•Information
Systems
Patients and
Families
•Health
knowledge
•Self-management skills
•Supportive
home
environment
Information
Systems
Healthy
Vermonters
The Vermont Department of Health
Self Management
Healthy Living Workshops
The Vermont Department of Health
Community
The Vermont Department of Health
Blueprint Budget 2006
By Focus Area
Community
9%
Health Systems
7%
Self
Management
9%
Provider
Practice
9%
Clinical
Registry
System
66%
The Vermont Department of Health
Blueprint for Health—FY 06
Community Services
•6 Master Trainers
•45 Instructors
•200 participants
•(200 more by 6/30)
•15 towns
•5 VDH staff
•5 Communities
•10 District offices
•18 towns-physical activity
•VT-211 in 2 pilot communities
•28 VDH staff participate
Information
Systems
•VHR to practices
•Registry Selected
•Practice needs
Analysis
•4 VDH staff
Self Management
Provider Practice
Health Systems
•Disease Management
Report
•Pay 4 Performance
(study started)
•1 VDH staff (PT)
•Pilots:
•19 Practices
•45 Providers
•1200 patients
•Others: 20 practices
•1VDH staff (PT)
The Vermont Department of Health
Healthy Living Participants
Medical 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
0.56
6.7
0.43
5.3
0.38
3.8
Baseline
6 Months
12 Months
Baseline
6 Months
12 Months
The Vermont Department of Health
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.
0 month
12 month
60%
54%
33%
Does Not Interfere With Normal Social
Activities
55%
53%
Does Not Interfere With Hobbies/Rec
Activities
38%
Does Not Interfere With Household
Chores
The Vermont Department of Health
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
0 month
12 month
72%
61%
72%
63%
57%
52%
51%
Walk at Least 30 M in/Wk
No Difficulty Walking Outdoors
61%
No Difficulting Dressing
No Difficulty Picking up
Clothing
The Vermont Department of Health
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.
The Vermont Department of Health
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.
The Vermont Department of Health
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
The Vermont Department of Health
Vermont Blueprint for Health
www.healthvermont.gov