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Vermont’s approach for medical homes began with a pilot in 2008. Three communities were selected to pilot an integrated care model, centered around providing patient-centered medical homes supported by community health teams. These pilot communities were part of Vermont’s Blueprint for Health (Blueprint), the state’s chronic care prevention and management plan.
 
The Vermont General Assembly has demonstrated their commitment to the Blueprint and improving the health and care of all Vermonters by passing multiple pieces of landmark legislation expanding access to medical homes.
Federal Support: Vermont is one of the eight states selected to participate in the Medicare Advanced Primary Care Practice (MAPCP) demonstration program.
 
Vermont has also received a duals demonstration grant from the Centers for Medicare & Medicaid Services (CMS) to “coordinate care across primary, acute, behavioral health and long-term supports and services for dual eligible individuals.”
 
Last Updated: April 2012

 

Forming Partnerships
Act 71 of the 2007-2008 legislative session created an executive committee to advise the director of the Blueprint for Health. The legislation requires government, provider, private payer, quality assurance, and consumer representation. Act 128 of the 2008-2009 legislative session expanded membership to include business and home health stakeholder representation.
 

The executive committee was charged with engaging insurance plans, professional organizations, community and nonprofit groups, consumers, businesses, school districts, and state and local government to create a five-year strategic plan.
Defining & Recognizing a Medical Home
Definition: Act 128 of the 2009-2010 legislative session requires that medical home providers:
  1. provide comprehensive prevention and disease screening for his or her patients and managing his or her patients’ chronic conditions by coordinating care;
  2. enable patients to have access to personal health information through a secure medium, such as through the Internet, consistent with federal health information technology standards;
  3. use a uniform assessment tool provided by the Blueprint in assessing a patient’s health;
  4. collaborate with the community health teams, including by developing and implementing a comprehensive plan for participating patients;
  5. ensure access to a patient’s medical records by the community health team members in a manner compliant with federal and state law; and
  6. meet regularly with the community health team to ensure integration of a participating patient’s care.

Recognition: NCQA PCMH recognition
Aligning Reimbursement & Purchasing
Practices receive enhanced per-member per-month (PMPM) payment ranging from $1.20-$2.39 that varies by NCQA PCMH recognition score, in addition to fee-for-service reimbursement.
 
All payers share responsibility in funding at total of $350,000 for each Community Health Team (CHT). CHTs consist of five FTEs for every 20,000 Vermonters in the CHT’s service area.
 

Prior to Medicare’s direct participation under the Medicare MAPCP demonstration, Vermont subsidized Medicare’s share of payments.
Supporting Practices
Practice support has included:
Measuring Results
The 2009 Blueprint for Health Annual Report describes the Blueprint’s evaluation infrastructure as including:
  • a centralized web based registry;
  • a multi-payer claims data base;
  • annual chart reviews;
  • routine independent scoring of practices based on NCQA PPC-PCMH standards;
  • analyses using data from public health registries on population indicators; and
  • an informatics and analytics platform with a web based reporting dashboard.

The 2010 Blueprint for Health Annual Report provides early, mixed results for the three pilot communities on a number of cost and quality metrics.