Vermont

ORIGIN AND MISSION The State of Vermont, under the leadership of its governor, legislature and the bipartisan Health Care Reform Commission, has established a 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 to focus on their prevention. The state’s strong commitment is demonstrated in the 2006 statutory codification of the Blueprint as the state’s plan for changing health care delivery. Further legislation in 2007 and 2008 strengthened the involvement of private insurance carriers. The annual state budget supports the health care transformation process, along with expanded use of health information technology and the development of a statewide health information exchange network. The Blueprint is a vision, a plan, and a statewide partnership to improve the state’s health care system and the health of Vermonters. It aims to shift the focus of the health care system to preventing illness and complications. The Blueprint started as an initiative to create a chronic care infrastructure and uniform model for providing chronic care in Vermont (its original pilot sites focused on diabetes). It has developed into a statewide health reform project that spans agencies and addresses the general population. The Blueprint quality improvement components include improved health maintenance, prevention, and chronic care management for a general population; financial reform that aligns incentives with health care goals; expanding the use of health information technology supported by an information exchange infrastructure; and a reporting and evaluation infrastructure that supports individual patient care, population management, quality improvement, and program evaluation. GOVERNANCE The director of the Vermont Blueprint reports to the commissioner of health and is responsible for implementing the program. The director coordinates the program across all levels of state government and with non-government partners. Blueprint goals are defined by the governor and legislation. The Blueprint is expected to work across agencies, sectors of society, and public-private partnerships. The director works with an Executive Committee, and a Planning & Evaluation Committee, as well as with advisory workgroups as needed. The FY 2009 Blueprint budget is about $4.8 million. The FY 2010 budget is just more than $4 million. Funding comes from the state’s global commitment (Medicaid program waiver savings) and the Catamount Fund (which includes Master Tobacco Settlement payments and an increase in cigarette tax). ACTIVITIES AND ACCOMPLISHMENTS Over the last three years, six Blueprint communities (authorized under Act 191) have implemented improved diabetes care and prevention via provider training and incentives, expanded use of health information technology, evidence-based process improvements, statewide self-management workshops, and statewide support for community activation and prevention programs. Legislation (Act 71, 2007 and Act 204, 2008) authorized the Blueprint to select three communities to participate in the Blueprint Integrated Pilot Program (BIPP) to assess the efficacy and sustainability of comprehensive, multi-payer reform for a general population. Blueprint supports participating pilot practices by helping them operate a patient-centered medical home (PCMH). A multidisciplinary Community Care Team provides care support for the PCMHs in a community. BPIPP also includes an infrastructure for multidimensional evaluation that encompasses measures of clinical processes, health status, and health care patterns and expenditures (via claims data from a multi-payer database populated by information from all insurers and third party administrators), as well as return on investment and financial impact. BIPP practices receive: •    Enhanced payment for meeting National Committee for Quality Assurance (NCQA) PCMH standards. •    Local multidisciplinary care support teams called Community Care Teams (CCTs), which include public health prevention specialists. •    A web-based clinical tracking system. •    Health information exchange between electronic medical records, hospital data sources, and a web-based clinical tracking system. BIPP Partners include: •    Private and public payers who share the costs of CCTs and have a common payment structure based on a practice’s NCQA PCMH score. •    Vermont Information Technology Leaders (VITL), a hospital and systems integration effort that supplies the HIE network and provides comprehensive data services that help practices implement EMRs. •    Vermont Program for Quality in Health Care (VPQHC), a private, non-profit corporation formed in 1988 with which the Blueprint has contracted to coordinate provider training and work with communities. VPQHC also provides registry reports via the Vermont Health Record (its chronic disease registry tool) and the web-based clinical tracking system.