Vermont Blueprint Integrated Pilot Program

Project Category: 
Insurer-Based
PROJECT STATUS
Target Start Date: 
Tuesday, July 1, 2008
Pilot/Demo Length: 
2-3 years

The State of Vermont, under the auspices of a true publicprivate partnership, has established an innovative program called the Blueprint for Health. The Blueprint is guiding a comprehensive and statewide process of transformation designed to reduce the health and economic impact of the most common chronic conditions and focus on their prevention. The Blueprint is helping primary care providers operate their practices as patient centered medical homes, offering well-coordinated care supported by local multidisciplinary teams, expanding use of Health IT, and assisting the development of a statewide health information exchange network and financial reform that sustains these processes and aligns fiscal incentives with health care goals.

This high level of care incorporates strategies to enhance self management and is closely integrated with community-wide public health and prevention efforts. The care coordination team, known as the Community Health Team (CHT) is a multidisciplinary group that partners with primary care offices, the hospital, and existing health and social service organizations to create, monitor, and evaluate a holistic community care coordination system in their service area. Services are free to all patients (no eligibility requirements), and the pilot is financed as a shared resource by Vermont’s major commercial and public payers.

CONVENING ENTITY/PROJECT CONTACTS
Convening Organization Name: 
Vermont Department of Health
Primary Contact: 
Lisa Dulsky Watkins, MD
E-mail: 
[email protected]
Phone: 
802/652-2095
Participating Stakeholders: 

Vermont Governor, James Douglas; Vermont State Legislature; Office of Vermont Health Access (VT Medicaid); Banking, Insurance, Securities and Health Care Agency; BCBSVT; MVP Health Plan; CIGNA; University of Vermont College of Medicine; Dartmouth Institute of Health Policy and Clinical Practice; Vermont Program for Quality in Health Care; Vermont Information Technology Leaders; Vermont Association of Hospitals and Health Systems; Vermont Medical Society; Vermont State Employees Association; IBM; Northeast Vermont Regional Hospital; Northern Counties Health Care; Fletcher Allen Health Care; Southwestern Vermont Medical Center; Central Vermont Medical Center; Mt. Ascutney Hospital; Springfield Hospital; IHI; AcademyHealth; Commonwealth Fund; Brookings Institution; Milbank Memorial Fund; AHRQ; PCPCC).

EXPECTED OR ACTUAL DEMOGRAPHICS OF PARTICIPATING PRACTICES
Number of Practices: 
14
Number of Participating Physicians: 
44
Physicians per practice: 
1-10
Types of Practices: 
Internal Medicine, Family Medicine
Health Plan Lines of Business Included: 
Commercial, Medicare Advantage, Medicaid Managed Care
Overall Number of Covered Lives: 
60000
Technology Characteristics at Start of Pilot: 

Estimated % of practices with practice management systems: >95%
Estimated % of practices with electronic medical record: 51-75%
Estimated % of practices with registry software: 51-75%
Other: Wide range of capacity from paper to integrated EMR with registry.

Consumer Involvement: 

Individual consumer surveys and focus groups as part of the evaluation. Consumers have also been involved as mentors for other patients and group facilitators.

PRACTICE TRANSFORMATION SUPPORT (INCLUDING TECHNOLOGY)
Focal areas of transformation: 

Care Coordination Increased Access Information Technology (e.g., registries, patient portals) New pay for performance models Team Approach to Care Other: Access to care coordination team WITHOUT cost to either the practice or the patient

Technology that participating practices have added as a result of their participation: 

The Blueprint is helping by offering expanded use of health information technology, assisting the development of a statewide health information exchange network, and offering at no cost the DocSite Web-based clinical tracking system. This can be used either directly or via an interface with the practice’s existing EMR.

Payment Model: 

Practices participating in the integrated pilots are provided with the care coordination infrastructure and financial incentives to operate a PCMH. The pilot practices are provided with enhanced payment through Vermont’s private insurers and Medicaid based on meeting nationally recognized quality standards and integration of local Community Health Teams (CHT) into clinical practice. This Blueprint-initiated payment reform ensures the program’s sustainability.

PROJECT EVALUATION
Types of data to be collected : 

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Provider Experience/Satisfaction Direct chart review, registry, multi-payer claims data base, public health sources (i.e., BRFSS, hospital discharge and disease prevalence data and immunization registry), qualitative collection (e.g., patient, provider surveys and focus groups)

Which of the data types are being shared?: 

Clinical outcomes, process measures, resource utilization.

Are the practices involved in the demonstration participating in any data sharing arrangements? If so please describe.: 

Yes. Practices will be able to compare themselves in a deidentified manner to other organizations via the Blueprint evaluation process. Demonstration project convening organization

Results to Share: 

We have preliminary information about the program. The 2010 Annual Report will contain information about the Integrated Pilot Program progress, with a full evaluation document (clinical and financial efficacy) due out in the next year.

Relevant links: 

Blueprint Web site: http://healthvermont.gov/blueprint.aspx 2009 Blueprint Annual Report: http://healthvermont.gov/admin/legislature/documents/ BlueprintAnnualReport0109.pdf