blueprint for health 101...•self-management programs empowering vermonters to help themselves...

Agency of Human Services

13/12/2019

March 2019

Blueprint for Health 101


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History

• Launched in 2003

• Codified into Vermont statute in 2006

• Modified 2007, 2008, and finally in 2010 with Vermont Act 128

• One of 8 states elected for Centers for Medicare and Medicaid Service’s (CMS) Multi-Payer Advanced Primary Care Practice Demonstration (2011)


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Act 128 Definition - Mission

“integrating a system of health care for patients, improving the health of the overall population, and

improving control over health care costs by promoting health maintenance, prevention, and care coordination

and management.”


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• Establish and sustain a network that can systematically test and implement innovative community-led strategies for improving health and well-being

• Rapidly respond to Vermont’s health and social service priorities through statewide implementation of new initiatives and service models

• Incorporate the innovation cycle - design, implementation, and research - into all initiatives and services

Purpose


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Blueprint for Health Central Office

• Currently located within the Agency of Human Services, Department of Vermont Health Access

• Responsive to federal programs, state legislators, insurers, health service areas, and other health and human service stakeholders

• Administers grants and contracts to build and support statewide Blueprint Transformation and Provider Network


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Beth Tanzman Executive DirectorNissa James Assistant DirectorMara Donohue Assistant DirectorErin Just Project AdministratorAlexandra Frey Project Administrator Mary Kate Mohlman Health Services ResearcherTim Tremblay Data Analytics and Info Administrator Vacant Data Analytics and Info AdministratorVacant Payment Operations AdministratorMaurine Gilbert Community Facilitator

Central Office Staff – March 1, 2019


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• Program Managers

• Quality Improvement Facilitators

• Community Health Team Leaders

• Medication Assisted Treatment Contacts

Contact information: https://blueprintforhealth.vermont.gov/contact-us

Statewide Network

https://blueprintforhealth.vermont.gov/contact-us


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Stakeholders• All AHS Departments – VDH, DMH, DAIL, etc.• Vermont Chronic Care Initiative• OneCare Vermont• Bi-State Primary Care Association• VCHIP• VPQHC• QIN-QIO

• Executive Committee/Evaluation and Planning Committee


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Partner Programs• Support and Services at Home (SASH)

• Partnership of non-profit housing, primary care, human service agencies, and hospitals working to support participants’ efforts to remain healthy and safe at home

• Vermont Chronic Care Initiative (VCCI)• Works with health care providers to identify

Medicaid and dually eligible members with complex needs who would benefit from care management services.


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• Patient Centered Medical Homes strong primary care foundation

• Community Health Teams bridge health and social services

• Self-management Programs empowering Vermonters to help themselves

• Hub and Spoke for opioid use disorder treatment

• Women’s Health Initiative increase pregnancy intention, healthy families

Blueprint Program Overview


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Patient Centered Medical Homes


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Strong Primary Care through Patient Centered Medical Homes


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Blueprint Patient Centered Medical Homes (PCMH)

• Active Engagement: Practices/Organizations annually pay a fee and register in a system called Q-PASS

• National Standards: Must achieve and sustain recognition as a PCMH from the National Committee on Quality Assurance (NCQA)

• Continuous Quality Improvement: Ongoing transformation work as a medical home


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• All-Payer (Medicare, Medicaid, BCBSVT, Cigna, MVP)

• As a result of being recognized as a PCMH, practices receive payments for– Attributed lives in the practice (Per Person Per Month)

– Outcomes (Utilization and Quality)

• Health Service Areas receive funds for staffing a Community Health Team

Payments


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Community Health Teams (PCMH)• Enable team-based primary care

• Provide care management and prevention services

• May be an embedded, centralized, or mixed model

• May include Registered Nurses, Care Coordinators, Social Workers, Panel Managers, Community Health Workers, Dietitians

• Vermonters have access to these services without having to make copayments, obtain prior authorizations, or meet eligibility criteria


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Patient Centered Medical Homes and Community Health Teams

• Started in 2008

• 137 (almost 138) participating Primary Care Practices (as of March 1, 2019)

• Approximately 162.4 FTEs

• > 800 unique providers

• > 300,000 attributed lives

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Blueprint PCMHs and CHTsJuly 2008 - December 2018

Recognized PCMHs As Of End of Qtr

Core CHT FTEs

PCMH Insurer-Attributed Patients

PCMH Medicaid-Attributed Patients


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3/12/201917

Payment Model

CHT Payments $2.77

BasePayment

to all eligible practices****

Quality

Utilization

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CHT - Community Payment Practice Payments

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Payment tied to practice results on Health

Partners Total Utilization Index

Payment tied to service area results*

based achieving benchmarks or percent

change on core measures:

• Diabetes, Poor Control – HbA1c>9%

• Controlling High Blood Pressure

• Developmental screening (1st three

years)

• Adolescent well-care visits

Payment tied to practice activity

• Participation in community initiatives**

• Recognition on NCQA standards***

*Incentive to work with community partners to improve service area results.

**Organize practice and CHT activity as part of at least one community quality initiative per year.

***Payment tied to recognition on NCQA PCMH standards with any qualifying score.

****Payments are for Commercial. Medicare and Medicaid pay a different rate.


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Research & Evaluation


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Self Management Programs


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• Evidence based group programs on tobacco cessation, diabetes prevention, chronic disease self-management, chronic pain self-management, diabetes self-management, Wellness Recovery Action Planning (mental well-being)

• Blueprint Program Managers and Self-Management Program Coordinators organize local workshops

• Community Health Improvement at the University of Vermont Medical Center offers statewide technical assistance and data collection

• Vermont Department of Health supports training of program leaders and marketing to potential participants

Helping Vermonters Self-Manage their Health


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2018 Self Management Programs


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https://myhealthyvt.org/


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New 2019 Self Management Offerings

• Online offering of diabetes prevention program

• Youth tobacco cessation program

• 1:1 Freshstart Support

• Youth specific Wellness Recovery Action Planning

• Workplace based chronic disease self-management program

• Falls prevention “Matter of Balance” program under consideration


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Hub & Spoke – Medication Assisted Treatment


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Vermont’s Response to Opioid Use Disorder

• Model has two levels of care

• High intensity (daily) methadone or buprenorphine along with therapy and other services

• Ongoing follow-up (weekly, monthly, or less frequently) care for medications, therapy, other services

• The Affordable Care Act (passed 2010) included a special Medicaid waiver that Vermont obtained to help subsidize the hub and spoke model.


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Hub & Spoke Model


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Blueprint Administration of Spokes

• Started 2013

• Over 85 Primary Care & Specialty Practices providing medication assisted treatment of opioid use disorder

• Funded by Medicaid, allows for Spoke Community Health Team (1 Nursing and 1 LADC/MA counsellor for every 100 Medicaid patients receiving MAT)

• The Blueprint and the Vermont Department of Health’s Division of Alcohol and Drug Abuse Programs (ADAP) offer ongoing training to Spoke prescribers and teams; learning collaboratives establish evidence based care


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Women’s Health Initiative


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• Women receive primary care and preventative care services in both Patient-Centered Medical Homes and obstetrics and gynecology practices.

• Through the Women’s Health Initiative, primary care and OB/GYN practices offer:– Enhanced health and psychosocial screening,

– Comprehensive family planning counseling, and

– Timely access to long acting reversible contraception (LARC)

• The aim is to help women be well, avoid unintended pregnancies, and build thriving families.

Healthy Women, Healthy Families


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• Started in 2017

• Primary care & women’s health practices

• Medicaid only

• Attest to:

– Psychosocial screening

– Family planning counseling

– Access to long acting reversible contraception (LARC)

– Building a community network

Women’s Health Initiative


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Payment Model• 3 forms of payment based on attribution of women ages 15

to 44:

- Recurring per member per month (PMPM) payments to WHI practices

- Recurring payments to support WHI Community Health Team (CHT) staff to the CHT administrative entities

- A one-time per member payment (PMP) to support stocking of Long Acting Reversible Contraceptive (LARC) devices to WHI practices.

• Paid by Medicaid only


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Under Development


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WHI Community Health Team• Embeds a licensed mental health provider into OB/GYN

practices

• Funds a floor of at least 0.5 full-time equivalent community health team member per (OB/GYN) practice

• Supplemental CHT payments, and by extension the number of full time equivalent (FTE) supplemental CHT staff members, are intended to be equal to approximately 1 FTE per every 1,200 patients.


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Coming Soon!


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Other Initiatives & Activities

• Broadening the definition of health and focusing on

prevention through Accountable Communities for Health

• Supporting a learning health system with Chronic Disease and other Learning Collaboratives

• Strengthening and supporting our network with

Community Health Team Trainings, All Field Team Meetings, the Blueprint for Health Annual Conference, and other educational and networking opportunities


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Blueprint 2019 Priorities


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• The aim for 2019 is to increase the number of sites with data in the Registry and increase the amount of usable information extracted from each individual record.

• Extensive project in collaboration with Vermont Health Information Exchange to improve:– Identity management services to better match records of care coming

from multiple organizations for a single individual

– Terminology services to help translate raw data into structured data and measures, and

– Capacity to aggregate and protect especially sensitive clinical information

Vermont Clinical Registry


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Data Offerings• Changing annual evaluation to align with the All Payer Model

• Updated Community Profiles to reflect “whole population”

• Improving timeliness of data

• Offering “deep dives” on topics/populations of interest

• WHI profiles – interactive format


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• Continuation of expansion of SBIRT initiative

• Implementation of universal screening for mental health, substance use, suicidality, interpersonal violence, housing security, and food security in all Primary Care and Emergency Department settings across the State

• Supplementary Community Health Team funds to embed staffing to provide brief interventions and support navigation to services

• Medicaid only; pending funding

Screening, Brief Intervention, and Navigation to Services (SBINS)


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• Increasing patient and provider access to non-opioid and non-interventional treatments for pain

• Testing multidisciplinary chronic pain care models in primary care and specialty pain clinics

• Providing coverage for services such as pain care management, complementary alternative modalities, and team conferencing

• Medicaid only; pending funding

Chronic Pain Pilots


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Health and Payment Reform in Vermont


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Vermont Health Reform Timeline

• 2010: Blueprint expansion statewide• 2011: The Green Mountain Care Board was established to

regulate hospital and insurance rates and oversee overall expenditures in the health care system.

• 2012: Accountable Care Organization (ACO) -based reform began with shared savings programs.

• 2013: Vermont received a State Innovation Model grant to support additional payment models, delivery system reforms, and health information technology improvements.


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Vermont Health Reform Timeline

• 2013: Vermont launched the Hub & Spoke Program (Blueprint and Department of Health)

• 2015: Act 54 – Administration and GMCB to explore waiver from Centers for Medicare and Medicaid Services (CMS)

• 2016: the state signed an agreement with the Centers for Medicare and Medicaid Services (CMS) to use an ACO model to control total cost of care and improve quality – the All Payer Accountable Care Organization Model

• 2017: Blueprint launches the Women’s Health Initiative.


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Vermont All-Payer Accountable Care Organization Model (APM)

• An all-payer model is an agreement between the State and the Center for Medicare and Medicaid Services (CMS) that allows Vermont to explore new ways of financing and delivering health care

• The all-payer model enables the three main payers of health care in Vermont – Medicaid, Medicare, and commercial insurance, to pay for health care differently than through fee-for-service reimbursement.


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APM Opportunities

• Greater focus on quality over volume; reward high value care

• Greater predictability for insurers and providers re: payment and reimbursement

• Improve access to preventative and primary care services

• Construct a integrated health care system• Opportunity to work across system of care and promote

care coordination


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APM Goals

• Limiting the annual growth in health care costs to 3.5% or less for included services

• Increasing access to primary care • Decreasing deaths due to suicide and drug overdoses;

and • Reducing morbidity and limiting the increase in

prevalence of three chronic illnesses (COPD, diabetes, HTN).


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Scale Targets


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Blueprint and ACO Collaboration

• Builds upon the networks established by the Blueprint for Health for many activities

• Work together to deliver quality improvement strategies and strategic initiatives driving toward the APM goals –e.g. care coordination, accountable communities for health, learning collaboratives


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APM Evaluation Early Findings• Lower health expenditures for patients attributed to

PCMHs• Higher chronic disease prevalence in PCMH patients, but

slower annual growth rate• More care occurring in outpatient settings than

inpatient• Large opportunity to improve care coordination across

settings for those with mental health conditions and substance use disorder

• Opportunity to reduce unnecessary healthcare utilization among healthier populations


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Resources


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https://blueprintforhealth.vermont.gov/

Implementation Materials – Vermont Blueprint for Health Manual

2018 Blueprint for Health Annual Report



blueprint for health 101...•self-management programs empowering vermonters to help themselves...

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