Health Reform and the Delivery System NASHP’s 23 rd  Annual State Health Policy Conference New Orleans, LA October 6, 2010...
Dulsky Watkins <ul><li>Health Care Reform 2010  </li></ul><ul><li>Convergence and Opportunity   </li></ul><ul><li>Vermont ...
Dulsky Watkins <ul><li>Vermont's Healthcare Reforms </li></ul><ul><li>Increased access </li></ul><ul><li>A primary care fo...
Dulsky Watkins Multi-insurer Payment Reforms Insurers <ul><li>Community Health Teams </li></ul><ul><li>Shared cost (core r...
<ul><li>Medicare beneficiaries have been supported through Vermont tax dollars </li></ul><ul><ul><li>Same access to Commun...
Dulsky Watkins The Vermont Accountable Care Organization Pilot: A Community Health System to Control Total Medical Costs a...
Dulsky Watkins <ul><li>Evaluation & Reporting (Data sources) </li></ul><ul><li>Electronic Medical Records </li></ul><ul><l...
Dulsky Watkins Blueprint Registry  (web-based and centralized)
Dulsky Watkins Multi Payer Claims Data Base 10/06/10 Expenditure Category  TOTAL Hospital Inpatient (billed by hospital) p...
Dulsky Watkins Community Health Team Referral and Communication Flow Chart  Behavioral Health Specialist Chronic Care Coor...
Dulsky Watkins Health IT Framework Evaluation Framework Medical Home Hospitals Public Health Programs & Services Community...
Questions <ul><li>Lisa Dulsky Watkins, MD </li></ul><ul><li>Associate Director, Vermont Blueprint for Health </li></ul><ul...
Upcoming SlideShare
Loading in …5
×

Blue Print for Health: Health Reform and the Delivery System

1,541 views

Published on

Published in: Health & Medicine
  • Be the first to comment

Blue Print for Health: Health Reform and the Delivery System

  1. 1. Health Reform and the Delivery System NASHP’s 23 rd Annual State Health Policy Conference New Orleans, LA October 6, 2010 Dulsky Watkins Lisa Dulsky Watkins, MD Associate Director, Vermont Blueprint for Health
  2. 2. Dulsky Watkins <ul><li>Health Care Reform 2010 </li></ul><ul><li>Convergence and Opportunity </li></ul><ul><li>Vermont Act 128 – Statewide expansion of medical homes, community health teams, and mandated multi-insurer payment reforms </li></ul><ul><li>Affordable Care Act – Comprehensive insurance reforms for increased accountability, lower costs and enhancing the quality of health care (Sections 3502 and 3503) </li></ul><ul><li>Multi-payer Advanced Primary Care Practice demonstration – Medicare to join state led multi-insurer payment reforms that support an advanced model of primary care. </li></ul>
  3. 3. Dulsky Watkins <ul><li>Vermont's Healthcare Reforms </li></ul><ul><li>Increased access </li></ul><ul><li>A primary care foundation </li></ul><ul><li>Multi-insurer payment reform </li></ul><ul><li>Focus on prevention (public health and health care delivery) </li></ul><ul><li>Statewide health information exchange </li></ul><ul><li>Evaluation infrastructure to support ongoing improvement </li></ul><ul><li>Facilitators & support for a learning health system </li></ul>
  4. 4. Dulsky Watkins Multi-insurer Payment Reforms Insurers <ul><li>Community Health Teams </li></ul><ul><li>Shared cost (core resource) </li></ul><ul><li>Consistent across insurers </li></ul><ul><li>Minimizes barriers </li></ul><ul><li>Patient Centered Medical Home </li></ul><ul><li>Payment to practices </li></ul><ul><li>Consistent across insurers </li></ul><ul><li>Promotes quality </li></ul><ul><li>Fee for Service </li></ul><ul><li>Unchanged </li></ul><ul><li>Allows competition </li></ul><ul><li>Promotes volume </li></ul>+ + <ul><li>Based on NCQA </li></ul><ul><li>PPC-PCMH score </li></ul><ul><li>and active case load </li></ul><ul><li>$1.20 - $2.49 PPPM </li></ul><ul><li>5 FTE / 20,000 general </li></ul><ul><li>population </li></ul><ul><li>$ 350,000/year </li></ul>
  5. 5. <ul><li>Medicare beneficiaries have been supported through Vermont tax dollars </li></ul><ul><ul><li>Same access to Community Health Teams </li></ul></ul><ul><ul><li>Same payment to primary care practices </li></ul></ul>Dulsky Watkins
  6. 6. Dulsky Watkins The Vermont Accountable Care Organization Pilot: A Community Health System to Control Total Medical Costs and Improve Population Health May 14, 2010 Authors: Jim Hester, Ph.D., Julie Lewis, and Aaron McKethan, Ph.D. Contact: Jim Hester, Ph.D., Director, Health Care Reform Commission, Vermont State Legislature, [email_address] Editor: Laurie Larson
  7. 7. Dulsky Watkins <ul><li>Evaluation & Reporting (Data sources) </li></ul><ul><li>Electronic Medical Records </li></ul><ul><li>Centralized Clinical Registry (DocSite) </li></ul><ul><li>Multi-insurer claims data base </li></ul><ul><li>Public Health Registries </li></ul><ul><li>Chart Reviews </li></ul><ul><li>NCQA Scoring </li></ul>
  8. 8. Dulsky Watkins Blueprint Registry (web-based and centralized)
  9. 9. Dulsky Watkins Multi Payer Claims Data Base 10/06/10 Expenditure Category TOTAL Hospital Inpatient (billed by hospital) prioritization used to assign by category Mental/Substance Inpatient (ICD 290-316=HEDIS) Private Psych Hospital Other Hospitals Maternity-related and newborns Surgical (non maternity, non-mental/substance) Medical (non maternity, non-mental/substance) Hospital Outpatient (billed by hospital) Prioritization Used to assign all services during that visit to that category Mental/Substance Hospital Outpatient Observation Bed Emergency Room Outpatient Surgery Outpatient Radiology Outpatient Lab Hospital-Dispensed Pharmacy Outpatient Physical Therapy Outpatient Other Therapy Other Outpatient Hospital Non-Mental Health Professional Services Physician Services Physician Inpatient Setting (site=21) Physician Outpatient Hospital Setting (site=22) Physician Office Setting (site=11) Physician Other Setting Other Professional Services Nurse Practitioners or Physician Assistants Physical Therapists Chiropractors Podiatrists Other Non-Hospital Mental Health Professional Services Psychiatrists Psychologists Social Workers including (MSWs, LICSW, LCSW) Mental Health Clinics Other Pharmacy Pharmacy in pharmacy file Pharmacy in medical claims All Other Services Free-standing Ambulatory Surgery Center Free-standing laboratory Independent radiology services Nursing Home Home Based Care (Home Health Agency) Durable Medical Equipment Other
  10. 10. Dulsky Watkins Community Health Team Referral and Communication Flow Chart Behavioral Health Specialist Chronic Care Coordinator Community Connections VT Department of Health Community Care Managers (Medicaid, AAA, Umbrella, etc.) Physicians Nurse Practitioners Physician Assistants COMMUNITY HEALTH TEAM PRIMARY CARE OFFICE
  11. 11. Dulsky Watkins Health IT Framework Evaluation Framework Medical Home Hospitals Public Health Programs & Services Community Health Team Nurse Coordinator Social Workers Nutrition Specialists Community Health Workers MCAID Care Coordinators Public Health Specialist Specialty Care & Disease Management Programs <ul><ul><li>A foundation of medical homes and community health teams that can support coordinated care and linkages with a broad range of services </li></ul></ul><ul><ul><li>Multi-insurer payment reform that supports a foundation of medical homes and community health teams </li></ul></ul><ul><ul><li>A health information infrastructure that includes EMRs, hospital data sources, a health information exchange network, and a centralized registry </li></ul></ul><ul><ul><li>An evaluation infrastructure that uses routinely collected data to support services, guide quality improvement, and determine program impact </li></ul></ul>Mental Health & Substance Abuse Programs Medical Home Medical Home Medical Home Social, Economic, & Community Services Healthier Living Workshops
  12. 12. Questions <ul><li>Lisa Dulsky Watkins, MD </li></ul><ul><li>Associate Director, Vermont Blueprint for Health </li></ul><ul><li>Vermont Department of Health Access </li></ul><ul><li>312 Hurricane Lane </li></ul><ul><li>Williston, VT 05495 </li></ul><ul><li>(802) 872-7535 </li></ul><ul><li>[email_address] </li></ul>Dulsky Watkins

×