blueprint for health 101...•self-management programs empowering vermonters to help themselves...
TRANSCRIPT
Agency of Human Services
13/12/2019
March 2019
Blueprint for Health 101
Agency of Human Services
23/12/2019
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)
Agency of Human Services
33/12/2019
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.”
Agency of Human Services
43/12/2019
• 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
Agency of Human Services
53/12/2019
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
Agency of Human Services
63/12/2019
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
Agency of Human Services
73/12/2019
• Program Managers
• Quality Improvement Facilitators
• Community Health Team Leaders
• Medication Assisted Treatment Contacts
Contact information: https://blueprintforhealth.vermont.gov/contact-us
Statewide Network
Agency of Human Services
83/12/2019
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
Agency of Human Services
93/12/2019
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.
Agency of Human Services
103/12/2019
• 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
Agency of Human Services
113/12/2019
Patient Centered Medical Homes
Agency of Human Services
123/12/2019
Strong Primary Care through Patient Centered Medical Homes
Agency of Human Services
133/12/2019
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
Agency of Human Services
143/12/2019
• 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
Agency of Human Services
153/12/2019
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
Agency of Human Services
163/12/2019
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
136
162.4
303,777
102,858
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
0
50
100
150
200
250
300
20
08Q
3
20
08Q
4
20
09Q
1
20
09Q
2
20
09Q
3
20
09Q
4
20
10Q
1
20
10Q
2
20
10Q
3
20
10Q
4
20
11Q
1
20
11Q
2
20
11Q
3
20
11Q
4
20
12Q
1
20
12Q
2
20
12Q
3
20
12Q
4
20
13Q
1
20
13Q
2
20
13Q
3
20
13Q
4
20
14Q
1
20
14Q
2
20
14Q
3
20
14Q
4
20
15Q
1
20
15Q
2
20
15Q
3
20
15Q
4
20
16Q
1
20
16Q
2
20
16Q
3
20
16Q
4
20
17Q
1
20
17Q
2
20
17Q
3
20
17Q
4
20
18Q
1
20
18Q
2
20
18Q
3
20
18Q
4
Att
rib
ute
d P
atie
nts
PC
MH
san
dC
ore
CH
T FT
Es
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
Agency of Human Services
173/12/2019
3/12/201917
Payment Model
CHT Payments $2.77
BasePayment
to all eligible practices****
Quality
Utilization
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
CHT - Community Payment Practice Payments
$P
PP
M
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.
Agency of Human Services
183/12/2019
Research & Evaluation
Agency of Human Services
193/12/2019
Self Management Programs
Agency of Human Services
203/12/2019
• 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
Agency of Human Services
213/12/2019
2018 Self Management Programs
Agency of Human Services
223/12/2019
https://myhealthyvt.org/
Agency of Human Services
233/12/2019
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
Agency of Human Services
243/12/2019
Hub & Spoke – Medication Assisted Treatment
Agency of Human Services
253/12/2019
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.
Agency of Human Services
263/12/2019
Hub & Spoke Model
Agency of Human Services
273/12/2019
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
Agency of Human Services
283/12/2019
Agency of Human Services
293/12/2019
Research & Evaluation
Agency of Human Services
303/12/2019
Women’s Health Initiative
Agency of Human Services
313/12/2019
• 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
Agency of Human Services
323/12/2019
• 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
Agency of Human Services
333/12/2019
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
Agency of Human Services
343/12/2019
Under Development
Agency of Human Services
353/12/2019
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.
Agency of Human Services
363/12/2019
Agency of Human Services
373/12/2019
Research & Evaluation
Coming Soon!
Agency of Human Services
383/12/2019
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
Agency of Human Services
393/12/2019
Blueprint 2019 Priorities
Agency of Human Services
403/12/2019
• 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
Agency of Human Services
413/12/2019
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
Agency of Human Services
423/12/2019
• 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)
Agency of Human Services
433/12/2019
• 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
Agency of Human Services
443/12/2019
Health and Payment Reform in Vermont
Agency of Human Services
453/12/2019
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.
Agency of Human Services
463/12/2019
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.
Agency of Human Services
473/12/2019
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.
Agency of Human Services
483/12/2019
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
Agency of Human Services
493/12/2019
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).
Agency of Human Services
503/12/2019
Scale Targets
Agency of Human Services
513/12/2019
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
Agency of Human Services
523/12/2019
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
Agency of Human Services
533/12/2019
Resources
Agency of Human Services
543/12/2019
https://blueprintforhealth.vermont.gov/
Implementation Materials – Vermont Blueprint for Health Manual
2018 Blueprint for Health Annual Report
https://blueprintforhealth.vermont.gov/contact-us