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Department of Vermont
Health Access
15/6/2015
Vermont Blueprint for Health:
Community System of Health
April 2015
Jenney S...
Department of Vermont
Health Access
25/6/2015
Components of the Blueprint
 Advanced Primary Care Practices/Patient Center...
Department of Vermont
Health Access
35/6/2015
 Multi-disciplinary quality improvement team
(Common set of Standards - NCQ...
Department of Vermont
Health Access
45/6/2015
Community Health Teams
 Multi-disciplinary supports designed locally throug...
Department of Vermont
Health Access
55/6/2015
Health IT Infrastructure
Evaluation & Comparative Reporting
Advanced
Primary...
Department of Vermont
Health Access
65/6/2015
CHT Services: Population Based & Care Coordination
 Proactive care across p...
Department of Vermont
Health Access
75/6/2015
Higher
Acuity &
Complexity
Lower
Acuity &
Complexity
Locus of Service & Supp...
Department of Vermont
Health Access
85/6/2015
Number of CHT Staff by Job Category Statewide
Department of Vermont
Health Access
95/6/2015
CHT Participation by Insurer
 32% Commercially
 24% Medicaid
 47% Medicare
Department of Vermont
Health Access
105/6/2015
Medicaid
Medicare
BlueCross
MVP
Cigna
Self Insured
Advanced Primary Care
NC...
Department of Vermont
Health Access
115/6/2015
Total Expenditures Per Capita - Commercially Insured Ages 18-64
$4,954
$5,5...
Department of Vermont
Health Access
125/6/2015
Total Expenditures Per Capita - Medicaid Ages 18-64 (excludes SMS)
$5,798
$...
Department of Vermont
Health Access
135/6/2015
Total Expenditures Per Capita for Special Medicaid Services Ages
18 - 64
$1...
Department of Vermont
Health Access
145/6/2015
Continued Evolution: BP and ACO
Collaboration
Department of Vermont
Health Access
155/6/2015
Transition to Community Health Systems
Current
PCMHs & CHTs
Community Netwo...
Department of Vermont
Health Access
165/6/2015
Action Steps
 Unified Community Collaboratives (quality, coordination)
 U...
Department of Vermont
Health Access
175/6/2015
Unified Community Collaboratives
 Unified local quality collaboratives (bl...
Department of Vermont
Health Access
185/6/2015
Unified Performance Reporting
 Co-produce comparative profiles
 Service a...
Department of Vermont
Health Access
195/6/2015
Data Utility
 Integration of diverse data sets for advanced measurement
 ...
Department of Vermont
Health Access
205/6/2015
Practice Profiles Evaluate Care Delivery
Commercial, Medicaid, & Medicare
Department of Vermont
Health Access
215/6/2015
Claims Data – PQI Composite (Chronic): Rate of Hospitalization
for ACS Cond...
Department of Vermont
Health Access
225/6/2015
22
Claims & Clinical Data – Hypertension: Blood Pressure in
Control (Core-3...
Department of Vermont
Health Access
235/6/2015
23
Claims & Clinical Data – Diabetes: Poor Control (Core-17, MSSP-27)
Department of Vermont
Health Access
245/6/2015
Base
Payment
NCQA 2011 2.25
average
Base
Payment
NCQA 2014
standards
3.50 t...
Department of Vermont
Health Access
255/6/2015
 Base Component: Based on NCQA recognition & UCC Participation.
o Requires...
Department of Vermont
Health Access
265/6/2015
Outcomes Services Coordination Incentives Measures
 Core measures & NCQA s...
Department of Vermont
Health Access
275/6/2015
Blueprint Website:
http://blueprintforhealth.vermont.gov/
Questions?
Jenney...
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Vermont Blueprint for Health: Community System of Health

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Jenney Samuelson
Assistant Director
Vermont Blueprint for Health
Department of Vermont Health Access

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Vermont Blueprint for Health: Community System of Health

  1. 1. Department of Vermont Health Access 15/6/2015 Vermont Blueprint for Health: Community System of Health April 2015 Jenney Samuelson Assistant Director Vermont Blueprint for Health Department of Vermont Health Access Jenney.Samuelson@state.vt.us
  2. 2. Department of Vermont Health Access 25/6/2015 Components of the Blueprint  Advanced Primary Care Practices/Patient Centered Medical Homes (PCMHs)  Community Health Teams  Community Based Self-management Programs  Multi-insurer payment reforms  Health Information Infrastructure  Evaluation & Reporting Systems  Learning Health System Activities
  3. 3. Department of Vermont Health Access 35/6/2015  Multi-disciplinary quality improvement team (Common set of Standards - NCQA PCMH recognition)  Seamless coordination of care (Design and implement CHT; CHT starts 6mo before NCQA)  Information technology (DocSite/VITL interface) Blueprint Advanced Primary Care Practices
  4. 4. Department of Vermont Health Access 45/6/2015 Community Health Teams  Multi-disciplinary supports designed locally through collaboration among medical, health, and humans service organizations  Work in communities and directly in practices  Functionally integrated into the practice setting 6 months prior to NCQA recognition  Team is scaled based on the number patients in the PCMHs they support ($350,000 per 20,000 patients attributed to participating PCMHs)  Core resource that is readily available to patients based on need  The ‘glue’ in a community system of health for the general population connecting health and human services
  5. 5. Department of Vermont Health Access 55/6/2015 Health IT Infrastructure Evaluation & Comparative Reporting Advanced Primary Care Hospitals Public Health Programs & Services Community Health Team Nurse Coordinator Social Workers Nutrition Specialists Community Health Workers Public Health Specialist Extended Community Health Team Medicaid Care Coordinators SASH Teams Spoke (MAT) Staff Specialty Care & Disease Management Programs Mental Health & Substance Abuse Programs Social, Economic, & Community Services Self Management Programs Advanced Primary Care Advanced Primary Care Advanced Primary Care All-Insurer Payment Reforms Local leadership, Practice Facilitators, Workgroups Local, Regional, Statewide Learning Forums  Service implementation designed locally through multi-agency collaboration bridging health, human services, and community resources  Foundation of medical homes and community health teams that support complex care coordination and population management and is linked to broad range of community services  Multi Insurer Payment Reforms fund medical home transformation and capacity for community health teams  Health information technology infrastructure including EMRs, hospital data sources, and a health information exchange for data aggregation  Evaluation infrastructure that produces actionable reports for practices, HSAs, organizations, ACOs and the State
  6. 6. Department of Vermont Health Access 65/6/2015 CHT Services: Population Based & Care Coordination  Proactive care across panel in a practice  Establishing new connections and redesigning delivery of services  New services provided are not covered by traditional health plans, focus on prevention  Shift to addressing social determinants (housing, food, transportation, activity)  Participants Identified for services by patients/client, clinicians, and social service providers
  7. 7. Department of Vermont Health Access 75/6/2015 Higher Acuity & Complexity Lower Acuity & Complexity Locus of Service & Support LevelofNeed • Health Maintenance • Prevention • Access • Communication • Self Management Support • Guideline Based Care • Coordinate Referrals • Coordinate Assessments • Panel Management • Specialty Care • Advanced Assessments • Advanced Treatments • Advanced Case Management • Social Services • Economic Services • Community Programs • Self Management Support • Public Health Programs Advanced Primary Care Practice Community Health Teams Specialized & Targeted Services Continuum of Health Services - General • Support Patients & Families • Support Practices • Coordinate Care • Coordinate Services • Referrals & Transitions • Specialized Supports o Medicaid - VCCI o Opiate Addiction o Medicare - SASH • Self Management Support • Counseling • Population Management
  8. 8. Department of Vermont Health Access 85/6/2015 Number of CHT Staff by Job Category Statewide
  9. 9. Department of Vermont Health Access 95/6/2015 CHT Participation by Insurer  32% Commercially  24% Medicaid  47% Medicare
  10. 10. Department of Vermont Health Access 105/6/2015 Medicaid Medicare BlueCross MVP Cigna Self Insured Advanced Primary Care NCQA Standards Patient Centered Care Access Communication Guideline Based Care Use of Health IT Community Support Community Health Teams MCAID CCs SASH Teams Fee for Service (Volume) $ PPPM - NCQA Score Specialized Services Hospitals Specialty Care Mental Health Services Substance Use Services Social Services Economic Services Long Term Care Nursing Homes Payment Reform Delivery System ReformFinancing Shared Costs Blueprint Payment Reforms
  11. 11. Department of Vermont Health Access 115/6/2015 Total Expenditures Per Capita - Commercially Insured Ages 18-64 $4,954 $5,519 $4,200 $4,400 $4,600 $4,800 $5,000 $5,200 $5,400 $5,600 $5,800 2008 2009 2010 2011 2012 2013 2013 Blueprint Practices 2013 Comparison Practices
  12. 12. Department of Vermont Health Access 125/6/2015 Total Expenditures Per Capita - Medicaid Ages 18-64 (excludes SMS) $5,798 $6,469 $5,000 $5,200 $5,400 $5,600 $5,800 $6,000 $6,200 $6,400 $6,600 $6,800 $7,000 2008 2009 2010 2011 2012 2013 2013 Blueprint Practices 2013 Comparison Practices
  13. 13. Department of Vermont Health Access 135/6/2015 Total Expenditures Per Capita for Special Medicaid Services Ages 18 - 64 $1,936 $1,227 $0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 2008 2009 2010 2011 2012 2013 2013 Blueprint Practices 2013 Comparison Practices Special Medicaid Services (SMS), such as transportation, residential treatment, dental, and home and community based services.
  14. 14. Department of Vermont Health Access 145/6/2015 Continued Evolution: BP and ACO Collaboration
  15. 15. Department of Vermont Health Access 155/6/2015 Transition to Community Health Systems Current PCMHs & CHTs Community Networks BP workgroups ACO workgroups Increasing measurement Multiple priorities Transition Unified Community Collaboratives Focus on core ACO quality metrics Common BP ACO dashboards Shared data sets Administrative Efficiencies Increase capacity • PCMHs, CHTs • Community Networks • Improve quality & outcomes Community Health Systems Novel financing Novel payment system Regional Organization Advanced Primary Care More Complete Service Networks Population Health
  16. 16. Department of Vermont Health Access 165/6/2015 Action Steps  Unified Community Collaboratives (quality, coordination)  Unified Performance Reporting & Data Utility  Increase support for medical homes and community health teams  Novel medical home payment model Strategy for Building Community Health Systems
  17. 17. Department of Vermont Health Access 175/6/2015 Unified Community Collaboratives  Unified local quality collaboratives (blend BP & ACO groups)  Focus on core ACO measures (add ACO measure dashboard)  Leadership team includes clinical leadership from ACOs, Mental Health Agency, Area Agency on Aging, Home Health Agency, Pediatrics, Housing Organization, to form a leadership team of up to 11 members  Convene community stakeholders  Regular leadership and workgroup meetings  Local groups adopt charter and select leadership  Guide quality & coordination initiatives
  18. 18. Department of Vermont Health Access 185/6/2015 Unified Performance Reporting  Co-produce comparative profiles  Service area and practice level profiles  Comparative results for expenditures, utilization, and quality  Include dashboard with results for core ACO measures  Possible through a linkage of claims and clinical data  Objective basis for planning and extension of best practices
  19. 19. Department of Vermont Health Access 195/6/2015 Data Utility  Integration of diverse data sets for advanced measurement  HSA profiles incorporate claims, clinical, BRFSS data  Claims and clinical data are linked for hybrid measures  Produce analytic data sets to meet ACO measurement needs  Share analytic data sets with ACOs  Collaborative work (VITL, others) to build data infrastructure
  20. 20. Department of Vermont Health Access 205/6/2015 Practice Profiles Evaluate Care Delivery Commercial, Medicaid, & Medicare
  21. 21. Department of Vermont Health Access 215/6/2015 Claims Data – PQI Composite (Chronic): Rate of Hospitalization for ACS Conditions (Core-12)
  22. 22. Department of Vermont Health Access 225/6/2015 22 Claims & Clinical Data – Hypertension: Blood Pressure in Control (Core-39, MSSP-28)
  23. 23. Department of Vermont Health Access 235/6/2015 23 Claims & Clinical Data – Diabetes: Poor Control (Core-17, MSSP-27)
  24. 24. Department of Vermont Health Access 245/6/2015 Base Payment NCQA 2011 2.25 average Base Payment NCQA 2014 standards 3.50 to all eligible practices Quality 0.75 Utilization 0.75 0.00 1.00 2.00 3.00 4.00 5.00 6.00 Current Proposed $PPPM Payment tied to service area results* • Performance payment based on benchmarks • Improvement payment based on change Payment tied to service area results* • Performance payment based on benchmarks • Improvement payment based on change Payment tied to practice activity • Participation in UCC initiatives** • Recognition on 2014 NCQA standards*** Comparison of current and proposed medical home payments *Incentive to work with UCC partners to improve service area results. **Organize practice and CHT activity as part of at least one UCC quality initiative per year. ***Payment tied to recognition on NCQA 2014 standards with any qualifying score. This emphasizes NCQAs priority ‘must pass’ elements while de-emphasizing the documentation required for highest score.
  25. 25. Department of Vermont Health Access 255/6/2015  Base Component: Based on NCQA recognition & UCC Participation. o Requires successful recognition on 2014 NCQA standards (any qualifying score) o Requires active participation in the local UCC including; orienting practice and CHT staff activities to achieve the goals that are prioritized by the local UCCs. Minimum requirement is active participation with at least one UCC priority initiative each calendar year. o All qualifying practices receive $3.50 PPPM  Quality Performance Component: Based on HSA results for Quality Index. o Up to $ 0.75 PPPM for results that exceed benchmark, or o Up to $ 0.50 PPPM for significant improvement if result is below benchmark  Utilization Performance Component: Based on HSA results for Utilization Index. o Up to $ 0.75 PPPM for results that exceed benchmark, or o Up to $ 0.50 PPPM for significant improvement if result is below benchmark Total Payment = Base + HSA Quality Performance + HSA TUI Performance Total Payment ranges from $3.50 to $5.00 PPPM Proposed Medical Home Payments
  26. 26. Department of Vermont Health Access 265/6/2015 Outcomes Services Coordination Incentives Measures  Core measures & NCQA standards provide a statewide framework  PCMH payment model incents quality & coordination  Community collaboratives guide quality & coordination initiatives  More effective health services & community networks  Health System (Accessible, Equitable, Patient Centered, Preventive, Affordable) Community Oriented Health Systems
  27. 27. Department of Vermont Health Access 275/6/2015 Blueprint Website: http://blueprintforhealth.vermont.gov/ Questions? Jenney.Samuelson@state.vt.us

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