Vermont Blueprint for Health

Sharon Moffatt

Commissioner of Health

August 2007

0%

10%

20%30%

40%

50%

60%

70%80%

90%

100%

U.S. Population Health Expenditures

Sickest 10 % Account for 64 % of Health Care Expenses

1%5%

10%

49%

64%

24%

Source: The Commonwealth Fund. Data from S. H. Zuvekas and J. W. Cohen, “Prescription Drugs and the Changing Concentration of Health Care Expenditures,” Health Affairs, Jan./Feb. 2007 26(1):249–57.

50%

97%

$36,280

$12,046

$6,992

$715

Expenditure threshold (2003 dollars)

Cost of Chronic Conditions is Both Personal and Financial

Care for people with chronic conditions accounts for83% of health care spending81% of hospital admissions76% of all physician visits91% of all prescriptions filled

Vermonters with Chronic Disease

Percent of Vermont Adults with Chronic Diseases

2001

0%10%20%30%40%50%60%70%80%90%

100%

None 1 or more 2 or more 3 or more 4 or more

all ages 65+

The Cost of ObesityOne-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

Vermont Adults Reporting Chronic Conditions by Body Mass Index

0

10

20

30

40

50

Non-gestational diabetes Ever had cardiovascular disease Arthritis

Healthy weight Overweight Class III ObeseSource: Vermont Behavioral Risk Factor Surveillance System 2001

Chronic Disease and Obesity

Deaths Per Thousand Adults

2.50

2.25

2.00

1.75

1.50

1.25

1980 1990

2000

2010

2020

2030

2040

2050Time (Year)

No Change

Obesity Prevention

Better Care

Reducing diabetes deaths: options

Deaths from complications–per thousand Adults

No major changes – status quo

Care and reduction in caloric intake

2.50

2.25

2.00

1.75

1.50

1.25

1980 1990 2000 2010 2020 2030 2040 2050

Time (Year)

Obesity Prevention and Better Care

No Change

Reducing diabetes deaths: comprehensive approach

The Model for Chronic Disease Care

Vermont Blueprint Model for Health

HealthyVermonters

Patients and Families

Community

HealthProvider Team

•Practice standards•Office Systems•Support•Information Systems

•Built Environment•Health Services•Health Awareness•Healthy Options•Information Systems

Health Systems

Public PolicyPublic Health

•System policy•Quality care•Reimbursement•Financing•Continuity•Coordination•Information Systems

•Policies•Infrastructure•Financing•Resources•Advocacy•Regulation•Information Systems

•Health knowledge•Self-manage- ment skills•Supportive home environmentInformation Systems

Blueprint Partnership

Public Policy

Governor Douglas has focused on investing in full System Approach

Blueprint for Health Fit and Healthy KidsDrug Enforcement, Treatment, Education

and Treatment (DETER )Catamount Health

Public Policy Legislation 2006 and 2007

Full support of Governor Douglas’s Blueprint Budget

Requires all private insurers, Medicaid and state employee health insurance to following Blueprint model

Requires all clinical guidelines to be the same for all insurers

Provider Practice and Health Systems

Best practice clinical standards for patient care

Microsystems change at practice levelSupport the patient with connections to

other parts of the health care system and the community

Use e-health tools to link information and resources to the provider and patient

Information Technology

Chronic Care Information System Supports medical decision making: Clinical standards built in to guide the clinical

care for individuals and targeted populations Provides reminders for recall visits Provides timely info from labs, specialties Emergency rooms will have immediate access to

patients’ medications list

Healthy Living ParticipantsMedical Care

6.7

5.3

3.8

Baseline 6 Months 12 Months

0.56

0.430.38

Baseline 6 Months 12 Months

MD Visits ED Visits

Visits to a health care provider’s office and the Emergency Dept decreased significantly at 6 & 12 months

Daily Activities Participants report, 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.

54%

33%38%

60%53% 55%

Does Not Interfere With Normal SocialActivities

Does Not Interfere With Hobbies/RecActivities

Does Not Interfere With HouseholdChores

0 month 12 month

Community

53% of Vermont Adults are obese or overweight

Communities have walking programs year round for all ages

Farmers’ Markets have doubled in the last

5 years

Community9%

Self Management

9%

Provider Practice

9%

Clinical Registry System

66%

Health Systems7%

Blueprint Budget 2006 By Focus Area

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

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.

Resources/References

Crossing the Quality Chasm: A New Health System for the 21st Centry, Institute of Medicine, National Academy of Sciences, 2001.

To Err is Human: Building a Safer Health System, Institute of Medicine, National Academy of Sciences, 2000.

Resources/ReferencesThe 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.

Vermont Department of Health website:

www.healthvermont.gov