blue print for health: health reform and the delivery system
TRANSCRIPT
Dulsky Watkins 1
Lisa Dulsky Watkins, MDAssociate Director, Vermont Blueprint for Health
Health Reform and the Delivery SystemNASHP’s 23rd Annual State Health Policy Conference
New Orleans, LA
October 6, 2010
Dulsky Watkins 2
Health Care Reform 2010 Convergence and Opportunity
Vermont Act 128 – Statewide expansion of medical homes, community health teams, and mandated multi-insurer payment reforms
Affordable Care Act – Comprehensive insurance reforms for increased accountability, lower costs and enhancing the quality of health care (Sections 3502 and 3503)
Multi-payer Advanced Primary Care Practice demonstration – Medicare to join state led multi-insurer payment reforms that support an advanced model of primary care.
Dulsky Watkins 3
Vermont's Healthcare ReformsIncreased access
A primary care foundation
Multi-insurer payment reform
Focus on prevention (public health and health care delivery)
Statewide health information exchange
Evaluation infrastructure to support ongoing improvement
Facilitators & support for a learning health system
Dulsky Watkins 4
Multi-insurer Payment Reforms
Insurers
•Community Health Teams•Shared cost (core resource)•Consistent across insurers•Minimizes barriers
•Patient Centered Medical Home•Payment to practices•Consistent across insurers•Promotes quality
•Fee for Service•Unchanged•Allows competition•Promotes volume
+ +
•Based on NCQA PPC-PCMH score and active case load•$1.20 - $2.49 PPPM
•5 FTE / 20,000 general population•$ 350,000/year
Dulsky Watkins 5
Medicare beneficiaries have been supported through Vermont tax dollars– Same access to
Community Health Teams
– Same payment to primary care practices
Dulsky Watkins 6
The Vermont Accountable Care Organization Pilot: A Community Health System to Control Total Medical
Costs and Improve Population Health
May 14, 2010 Authors: Jim Hester, Ph.D., Julie Lewis, and Aaron
McKethan, Ph.D. Contact: Jim Hester, Ph.D., Director, Health Care Reform
Commission, Vermont State Legislature, [email protected] Editor: Laurie Larson
Dulsky Watkins 7
Evaluation & Reporting (Data sources)
Electronic Medical Records
Centralized Clinical Registry (DocSite)
Multi-insurer claims data base
Public Health Registries
Chart Reviews
NCQA Scoring
Dulsky Watkins 88
Blueprint Registry (web-based and centralized)
Dulsky Watkins 9
Multi Payer Claims Data BaseExpenditure Category TOTAL
Hospital Inpatient (billed by hospital) prioritization used to assign by category Mental/Substance Inpatient (ICD 290-316=HEDIS) Private Psych Hospital Other Hospitals Maternity-related and newborns Surgical (non maternity, non-mental/substance) Medical (non maternity, non-mental/substance)
Hospital Outpatient (billed by hospital) Prioritization Used to assign all services during that visit to that category Mental/Substance Hospital Outpatient Observation Bed Emergency Room Outpatient Surgery Outpatient Radiology Outpatient Lab Hospital-Dispensed Pharmacy Outpatient Physical Therapy Outpatient Other Therapy Other Outpatient HospitalNon-Mental Health Professional Services Physician Services Physician Inpatient Setting (site=21) Physician Outpatient Hospital Setting (site=22) Physician Office Setting (site=11) Physician Other Setting Other Professional Services Nurse Practitioners or Physician Assistants Physical Therapists Chiropractors Podiatrists OtherNon-Hospital Mental Health Professional Services Psychiatrists Psychologists Social Workers including (MSWs, LICSW, LCSW) Mental Health Clinics OtherPharmacy Pharmacy in pharmacy file Pharmacy in medical claims All Other Services Free-standing Ambulatory Surgery Center Free-standing laboratory Independent radiology services Nursing Home Home Based Care (Home Health Agency) Durable Medical Equipment Other
04/12/23 9
Dulsky Watkins 10
Behavioral Health
Specialist
Chronic Care Coordinator
Community Connections
VT Department of Health
Community Care Managers
(Medicaid, AAA, Umbrella, etc.)
Physicians
Nurse Practitioners
Physician Assistants
COMMUNITY HEALTH TEAM
PRIMARY CARE OFFICE
Community Health TeamReferral and Communication Flow Chart
Dulsky Watkins 11
Health IT Framework
Evaluation Framework
Medical Home
Hospitals
Public Health Programs & Services
Community Health TeamNurse Coordinator
Social WorkersNutrition Specialists
Community Health WorkersMCAID Care Coordinators
Public Health Specialist
Specialty Care & Disease Management Programs
A foundation of medical homes and community health teams that can support coordinated care and linkages with a broad range of services
Multi-insurer payment reform that supports a foundation of medical homes and community health teams
A health information infrastructure that includes EMRs, hospital data sources, a health information exchange network, and a centralized registry
An evaluation infrastructure that uses routinely collected data to support services, guide quality improvement, and determine program impact
Mental Health & Substance Abuse
Programs
Medical Home
Medical Home
Medical Home
Social, Economic, & Community Services
Healthier Living Workshops
Dulsky Watkins 12
Questions
Lisa Dulsky Watkins, MDAssociate Director, Vermont Blueprint for Health
Vermont Department of Health Access312 Hurricane LaneWilliston, VT 05495
(802) [email protected]