vermont blueprint for health integrated pilot programs pcpcc call lisa dulsky watkins, md vermont...

Vermont Blueprint for Health Integrated Pilot Programs

PCPCC Call

Lisa Dulsky Watkins, MDVermont Department of Health

January 20, 2009

Vision

Vermont will have a statewide system of care that improves the

lives

of individuals with and at risk for chronic conditions

Improved Outcomes-Healthier People

ProductiveInteractions

Self-Management

Support

DeliverySystemDesign

DecisionSupport

ClinicalInformation

Systems

Health System

Health Care Organization

Community Resources and

PoliciesPublic HealthPolicies, Systems,

Environment

Supportive Environment

Informed,Activated

Patient

Prepared,Proactive

Practice Team

Adapted from the chronic care model which is used by permission of “Effective Clinical Practice.”

What is the Blueprint?

Who are the players?• State Government

– Executive and Legislative branches– Department of Health

• Over 100 volunteers serving on committees and workgroups• Insurers – publicly and privately funded• University of Vermont College of Medicine• Vermont Information Technology Leaders• Local and national QI organizations

– Vermont Program for Quality in Health Care – Institute for Healthcare Improvement – Agency for Healthcare Research and Quality– AcademyHealth/Commonwealth Fund

• Providers – MD, DO, NP, PA, nursing and office staff• Patients and families

Bennington

Burlington

St. Johnsbury

Barre

Springfield

Windsor2005—Initial two pilot Hospital Service Areas (Diabetes Focus)

Healthier Living Workshops

Community Physical Activity Grants

April 2007

2004—Planning

2003—Launch of the Blueprint

2006—Four new Hospital Service Areas (Diabetes Focus)

Blueprint DevelopmentBlueprint Development

2006—Statutory Endorsement

2007— Medical Home Integrated Pilots in Statute

2009 - Integrated Medical Home Pilots(all chronic conditions + prevention)

Health Care Reform Legislation2006

Health Care Affordability Acts (Acts 190, 191) Common Sense Initiatives (Appropriations Bill) Sorry Works! (Act 142) Safe Staffing and Quality Patient Care (Act 153)

2007 Corrections and Clarifications to the Health Care Affordability Acts of 2006 (Act

70) An Act relating to Ensuring Success in Health Care Reform (Act 71)

2008 An Act Relating to Health Care Reform (Act 203) An Act Relating to Managed Care Organizations and the Blueprint for Health

(S.283)

Blueprint Integrated Pilot Summary

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

Primary Care PCMH-Docs-NPs-PAs-MAs-Staff

Community Care Team (CCT)e.g. NP, RN, MSW, Dietician,Behavior Specialist, Community Health Worker, VDH Public Health Specialist

CCT SupportPanel ManagementCoachingPatient / family contactAssessmentReinforce treatment planEducationRemindersSelf management

Social / Economic SupportLiaison to other programsEnrollment assistance

Prevention & Self ManagementReferral to community programsCoordinate community programs

Vermont Health Information Platform (VITL)

Referral & care support Education & Improvement

PCMHPayment reformComprehensive guideline based careHealth maintenance & preventionChronic conditionsPanel managementCoachingRemindersGoal settingHealth IT – planned visitsHealth IT – population managementHealth IT – eRxPaper based or EMR practices

Referrals,Communication& QI Planning

Blueprint Integrated Pilot Model

Primary Care PCMH-Docs-NPs-Staff

Community Care Team (CCT)e.g. NP, RN, MSW, Dietician,Behavior Specialist, Community Health Worker, VDH Public Health Specialist

Referrals &Communication

Vermont Health Information Platform (VITL)

Hospital-Educators-Transitional care-Ambulatory center (wellness programs)

Referral & care support Education & Quality Improvement

Policies and SystemsLocal, state, and federal policies and laws, economic and cultural influences, media

CommunityPhysical, social and cultural

environment

OrganizationsSchools, worksites, faith-based

organizations, etcRelationships

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.

Model for Health & Prevention

Prevention

Healthcare

PHASE 4 - Implementation

Timeline depends on scope and resources of planned intervention

PHASE 3 - Community Planning

Planning with key leadersPlanning with stakeholdersIterative interactive processConsensus building

PHASE 2b - Community Assessment

Quantitative Context - state level 10 year trend analysis of risk factors associated with morbidity & healthcare costs

Focus groupsFormal key leader interviewsContinue until no new themesTest themes in new interviewsTest findings in community forums

Phase 5 – Evaluation

2 - 4 months

4 - 6 months

3 - 5 months

PHASE 2a - Community Profile

Community description Community inventoryQuantitative Context - Descriptive health statistics

on the rates of risk factors in each community (5 year aggregate data)

PHASE I - Develop capacity

Facilitate systems approachTrain Prevention Specialist

Prevention Model and FrameworkData collection techniquesEnvironment and policy change

Community Assessment & Planning TimelineOctober 2008

Pilot Site # Provider # Patients

Community Practice

St. Johnsbury

Caledonia Internal Medicine 3 2,011

Concord Health Center 2 2,183

Corner Medical 6 14,500

Danville Health Center 2 3,088

St. Johnsbury Family Health Center 2 2,822

Total St Johnsbury 15 24,604

Burlington

Fletcher Allen AffiliatedAesculapius Medical Center 9 15,774

Private Practice – Non Affiliated 1 1,800

Total Burlington 10 17,574

Bennington

Planning stages

Total (first 2 sites only) 25 42,178

Pilot # 1

Pilot # 2

Pilot # 3

Standards

NCQA PCMH PointsAverage PPPM

Payment

0 0.00

5 0.00

10 0.00

15 0.00

20 0.00

25 1.20

30 1.28

35 1.36

40 1.44

45 1.52

50 1.60

55 1.68

60 1.76

65 1.84

70 1.92

75 2.00

80 2.07

85 2.15

90 2.23

95 2.31

100 2.39

Provider Payment Table($PPPM for each provider)

Requires 5 of 10 must pass elements

Requires 10 of 10 must pass elements

Practice Evaluation & Quality Improvement

QI (current) Clinical Microsystems Training VHR DocSite

Evaluation (current) Chart Review ACIC (readiness) Focus Groups

Evaluation (integrated pilot) Review against NCQA standards Onsite Review Analysis of DocSite data Report based on NCQA scoring

Payment

Evaluation (Integrated pilot) Use reports Guide Microsystems Training Guide QA / QI planning Focused on NCQA PCMH Stds

Ongoing QA / QI

Practice Evaluation & Payment Model

Evaluator’sReport

NCQAReview

Start PaymentRetroactive to index date$ PPPM calculation -initial NCQA score -active patient panelActive patient panel (attribution) -visit <12 months to practice PCP -eligibility checkPaid quarterly or Monthly (payer defined)

30days

30days

Evaluator’sReport

NCQAReview

6 months

Adjust PaymentRetroactive to 6 month interval date$ PPPM calculation -refreshed NCQA score -refreshed active patient panelActive patient panel (attribution) -visit <12 months to practice PCP -eligibility checkPaid quarterly or Monthly (payer defined)

07 / 08 10 / 08 07 / 09 10 / 09 07 / 2010

Pilot # 1

Pilot # 2

Pilot # 3

01 / 09 01 / 2010

Category Data Source Evaluation Outline

PCMH healthcare process quality NCQA PCMH ScoreVCHIP practice reviewNCQA recognition

Integrated Pilot practices Change from baseline

Clinical process measures DocSite data baseVCHIP Chart Review

Integrated Pilot practices Practices delivering routine care Change from baseline & comparison

Health status measures DocSite data baseVCHIP 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 databaseFinancial 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

Blueprint Pilot Timeline & Evaluation

HealthcarePatterns &

Resource Utilization

Healthcare Expenditures & Financial Impact

HealthStatus

Measures

ClinicalProcess

Measures

Population Indicators &Risk Factors

Healthcare Quality Measures & Standards

Population Management

Quality Improvement

Program Evaluation & Sustainability

Community Prevention Planning

Individual Patient Care & Support

Services

Provider Payment for

Quality

Data Processing & Storage

EMRs used forIndividual Patient

Care

DocSite used forIndividual Patient

Care

DocSite Database

EMR Databases

DocSiteReporting

Tool

VCHIPChart Review & NCQA Scoring

Medical Claims from Commercial

Insurers & Medicaid

Public Health Surveys & Data

Collection

DataSource

Data transmission & transformation

VITL / GE

DataAnalysis

Data Reports & Uses

EMRReporting Tool or

Analyst

Public HealthRegistries & Databases

VDH Health Surveillance

Analytic Database

BISCHAMultipayerDatabase

VCHIPDatabases

VCHIPAnalysis & Report

Generation

BISCHAReports


Analyst

ContractedAnalysisServices

Blueprint Integrated PilotsEvidence Based Quality Improvement


Quality Improvement


Services



Care


Care


Care

DocSite Database

EMR Databases

DocSiteReporting

Tool






Insurers & Medicaid


Insurers & Medicaid


Collection


Collection

DataSource


VITL / GE

DataAnalysis

Data Reports & Uses


Analyst




Analytic Database


Analytic Database



VCHIPDatabases

VCHIPDatabases


Generation


Generation

BISCHAReports

BISCHAReports








Analyst


Analyst

HealthStatus

Measures

ClinicalProcess

Measures










Quality


Quality




Quality Improvement



Care


Care


Care


Care

DocSite DatabaseDocSite Database

EMR Databases

EMR Databases

DocSiteReporting

Tool

DocSiteReporting

Tool






Insurers & Medicaid


Collection


Collection

DataSource


VITL / GE


VITL / GE

DataAnalysis

Data Reports & Uses


Analyst


Analyst




Analytic Database


Analytic Database


VCHIPDatabases

VCHIPDatabases


Generation


Generation

BISCHAReports





Analyst


Analyst

HealthStatus

Measures

HealthStatus

Measures

ClinicalProcess

Measures

ClinicalProcess

Measures






Services


Services




Quality


Quality


Blueprint Integrated PilotsFinancial Impact

2009 2010 2011 2012 2013Percentage of Vermont population participating 6.7% 9.8% 13.0% 20.0% 40.0%

Participating population 42,179 61,880 82,332 127,045 254,852

# Community Care Teams 2 3 4 6 13

Blueprint Integrated PilotsPlan for statewide expansion

BP Integrated PilotExperience

ContinuousQuality

ImprovementUse experience from

Integrated Pilot program to refine &

target BP Community grants. Build capacity & readiness for more complete healthcare

reform. BP Community Experience

ContinuousQuality

Improvement

Transform from BP Community to

Integrated Pilot Community, and/or,

expand existing Integrated Pilot to

include more Blueprint practices in a community

Shift BP Grant to new community or expand across a community

Build a model for effective and sustainable healthcare reform

Multi payer financial reform (from volume to quality)

Healthcare environment (PCMH, CCTs, PH specialists, Health IT)

Healthcare focus (from sick care to wellness / prevention)

Healthcare culture (evidence based QI)

Blueprint Integrated PilotsBuilding a Scalable Model

Contact Information

Lisa Dulsky Watkins, MDAssistant Director

Vermont Blueprint for HealthVermont Department of Health

Burlington, [email protected]

(802) 652-2095

mailto:[email protected]

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vermont blueprint for health integrated pilot programs pcpcc call lisa dulsky watkins, md vermont...

Documents

health care reform act

health care institute

quality patient care

chronic care model

community health worker

statewide system of

managed care organizations

clinical measures