vermont blueprint for health: community system of health
TRANSCRIPT
Department of Vermont Health Access
104/15/2023
Vermont Blueprint for Health: Community System of Health
April 2015
Jenney SamuelsonAssistant Director
Vermont Blueprint for HealthDepartment of Vermont Health Access
Department of Vermont Health Access
204/15/2023
Components of the Blueprint
Advanced Primary Care Practices/Patient Centered Medical Homes (PCMHs)
Community Health Teams
Community Based Self-management Programs
Multi-insurer payment reforms
Health Information Infrastructure
Evaluation & Reporting Systems
Learning Health System Activities
Department of Vermont Health Access
304/15/2023
Multi-disciplinary quality improvement team (Common set of Standards - NCQA PCMH recognition)
Seamless coordination of care (Design and implement CHT; CHT starts 6mo before NCQA)
Information technology (DocSite/VITL interface)
Blueprint Advanced Primary Care Practices
Department of Vermont Health Access
404/15/2023
Community Health Teams
Multi-disciplinary supports designed locally through collaboration among medical, health, and humans service organizations
Work in communities and directly in practices
Functionally integrated into the practice setting 6 months prior to NCQA recognition
Team is scaled based on the number patients in the PCMHs they support ($350,000 per 20,000 patients attributed to participating PCMHs)
Core resource that is readily available to patients based on need
The ‘glue’ in a community system of health for the general population connecting health and human services
Department of Vermont Health Access
504/15/2023
Health IT Infrastructure
Evaluation & Comparative Reporting
Advanced Primary
Care
Hospitals
Public Health Programs & Services
Community Health TeamNurse Coordinator
Social WorkersNutrition Specialists
Community Health WorkersPublic Health Specialist
Extended Community Health TeamMedicaid Care Coordinators
SASH TeamsSpoke (MAT) Staff
Specialty Care & Disease Management Programs
Mental Health & Substance Abuse
Programs
Social, Economic, & Community Services
Self Management Programs
Advanced Primary
Care
Advanced Primary
Care
Advanced Primary
Care
All-Insurer Payment Reforms
Local leadership, Practice Facilitators, Workgroups
Local, Regional, Statewide Learning Forums
Service implementation designed locally through multi-agency collaboration bridging health, human services, and community resources
Foundation of medical homes and community health teams that support complex care coordination and population management and is linked to broad range of community services
Multi Insurer Payment Reforms fund medical home transformation and capacity for community health teams
Health information technology infrastructure including EMRs, hospital data sources, and a health information exchange for data aggregation
Evaluation infrastructure that produces actionable reports for practices, HSAs, organizations, ACOs and the State
Department of Vermont Health Access
604/15/2023
CHT Services: Population Based & Care Coordination Proactive care across panel in a practice Establishing new connections and redesigning delivery of services New services provided are not covered by traditional health plans, focus on
prevention Shift to addressing social determinants (housing, food, transportation, activity) Participants Identified for services by patients/client, clinicians, and social service
providers
Department of Vermont Health Access
704/15/2023
HigherAcuity &
Complexity
LowerAcuity &
Complexity
Locus of Service & Support
Level of N
eed
• Health Maintenance• Prevention• Access• Communication• Self Management Support• Guideline Based Care• Coordinate Referrals• Coordinate Assessments• Panel Management
• Specialty Care• Advanced Assessments• Advanced Treatments• Advanced Case Management• Social Services• Economic Services• Community Programs• Self Management Support• Public Health Programs
Advanced PrimaryCare Practice
Community HealthTeams
Specialized & TargetedServices
Continuum of Health Services - General
• Support Patients & Families• Support Practices• Coordinate Care• Coordinate Services• Referrals & Transitions• Specialized Supports
o Medicaid - VCCIo Opiate Addictiono Medicare - SASH
• Self Management Support• Counseling• Population Management
Department of Vermont Health Access
804/15/2023
Number of CHT Staff by Job Category Statewide
Department of Vermont Health Access
904/15/2023
CHT Participation by Insurer
32% Commercially 24% Medicaid 47% Medicare
Department of Vermont Health Access
1004/15/2023
10
MedicaidMedicareBlueCrossMVPCignaSelf Insured
Advanced Primary CareNCQA StandardsPatient Centered CareAccessCommunicationGuideline Based CareUse of Health IT
Community SupportCommunity Health TeamsMCAID CCsSASH Teams
Fee for Service (Volume)
$ PPPM - NCQA Score
Specialized Services
HospitalsSpecialty CareMental Health ServicesSubstance Use ServicesSocial ServicesEconomic ServicesLong Term CareNursing Homes
Payment Reform Delivery System ReformFinancing
Shared Costs
Blueprint Payment Reforms
Department of Vermont Health Access
1104/15/2023
Total Expenditures Per Capita - Commercially Insured Ages 18-64
2008 2009 2010 2011 2012 2013$4,200
$4,400
$4,600
$4,800
$5,000
$5,200
$5,400
$5,600
$5,800
$4,954
$5,519
2013 Blueprint Practices
2013 Comparison Practices
Department of Vermont Health Access
1204/15/2023
Total Expenditures Per Capita - Medicaid Ages 18-64 (excludes SMS)
2008 2009 2010 2011 2012 2013$5,000
$5,200
$5,400
$5,600
$5,800
$6,000
$6,200
$6,400
$6,600
$6,800
$7,000
$5,798
$6,469
2013 Blueprint Practices
2013 Compar-ison Practices
Department of Vermont Health Access
1304/15/2023
Total Expenditures Per Capita for Special Medicaid Services Ages 18 - 64
2008 2009 2010 2011 2012 2013$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$1,936
$1,227
2013 Blueprint Practices
2013 Comparison Practices
Special Medicaid Services (SMS), such as transportation, residential treatment, dental, and
home and community based services.
Department of Vermont Health Access
1404/15/2023
Continued Evolution: BP and ACO Collaboration
Department of Vermont Health Access
1504/15/2023
Transition to Community Health Systems
Current
PCMHs & CHTs
Community Networks
BP workgroups
ACO workgroups
Increasing measurement
Multiple priorities
Transition
Unified Community Collaboratives
Focus on core ACO quality metrics
Common BP ACO dashboards
Shared data sets
Administrative Efficiencies
Increase capacity• PCMHs, CHTs
• Community Networks
• Improve quality & outcomes
Community Health Systems
Novel financing
Novel payment system
Regional Organization
Advanced Primary Care
More Complete Service Networks
Population Health
Department of Vermont Health Access
1604/15/2023
Action Steps
Unified Community Collaboratives (quality, coordination)
Unified Performance Reporting & Data Utility
Increase support for medical homes and community health teams
Novel medical home payment model
Strategy for Building Community Health Systems
Department of Vermont Health Access
1704/15/2023
Unified Community Collaboratives
Unified local quality collaboratives (blend BP & ACO groups)
Focus on core ACO measures (add ACO measure dashboard)
Leadership team includes clinical leadership from ACOs, Mental Health Agency,
Area Agency on Aging, Home Health Agency, Pediatrics, Housing Organization, to
form a leadership team of up to 11 members
Convene community stakeholders
Regular leadership and workgroup meetings
Local groups adopt charter and select leadership
Guide quality & coordination initiatives
Department of Vermont Health Access
1804/15/2023
Unified Performance Reporting
Co-produce comparative profiles
Service area and practice level profiles
Comparative results for expenditures, utilization, and quality
Include dashboard with results for core ACO measures
Possible through a linkage of claims and clinical data
Objective basis for planning and extension of best practices
Department of Vermont Health Access
1904/15/2023
Data Utility
Integration of diverse data sets for advanced measurement
HSA profiles incorporate claims, clinical, BRFSS data
Claims and clinical data are linked for hybrid measures
Produce analytic data sets to meet ACO measurement needs
Share analytic data sets with ACOs
Collaborative work (VITL, others) to build data infrastructure
Department of Vermont Health Access
2004/15/2023
Practice Profiles Evaluate Care DeliveryCommercial, Medicaid, & Medicare
Department of Vermont Health Access
2104/15/2023
Claims Data – PQI Composite (Chronic): Rate of Hospitalization for ACS Conditions (Core-12)
Department of Vermont Health Access
2204/15/202322
Claims & Clinical Data – Hypertension: Blood Pressure in Control (Core-39, MSSP-28)
Department of Vermont Health Access
2304/15/202323
Claims & Clinical Data – Diabetes: Poor Control (Core-17, MSSP-27)
Department of Vermont Health Access
2404/15/2023
Current Proposed0.00
1.00
2.00
3.00
4.00
5.00
6.00
BasePaymentNCQA 2011
2.25average
BasePayment
NCQA 2014 standards
3.50 to all eligible practices
Quality0.75
Utilization0.75
$PPP
M
Payment tied to service area results*• Performance payment based on
benchmarks• Improvement payment based on
change
Payment tied to service area results*• Performance payment based on
benchmarks• Improvement payment based on
change
Payment tied to practice activity• Participation in UCC initiatives**• Recognition on 2014 NCQA
standards***
Comparison of current and proposed medical home payments
*Incentive to work with UCC partners to improve service area results. **Organize practice and CHT activity as part of at least one UCC quality initiative per year.***Payment tied to recognition on NCQA 2014 standards with any qualifying score. This emphasizes NCQAs priority ‘must pass’ elements while de-emphasizing the documentation required for highest score.
Department of Vermont Health Access
2504/15/2023
Base Component: Based on NCQA recognition & UCC Participation. o Requires successful recognition on 2014 NCQA standards (any qualifying score)o Requires active participation in the local UCC including; orienting practice and CHT staff activities to achieve
the goals that are prioritized by the local UCCs. Minimum requirement is active participation with at least one UCC priority initiative each calendar year.
o All qualifying practices receive $3.50 PPPM
Quality Performance Component: Based on HSA results for Quality Index.o Up to $ 0.75 PPPM for results that exceed benchmark, oro Up to $ 0.50 PPPM for significant improvement if result is below benchmark
Utilization Performance Component: Based on HSA results for Utilization Index.o Up to $ 0.75 PPPM for results that exceed benchmark, oro Up to $ 0.50 PPPM for significant improvement if result is below benchmark
Total Payment = Base + HSA Quality Performance + HSA TUI Performance
Total Payment ranges from $3.50 to $5.00 PPPM
Proposed Medical Home Payments
Department of Vermont Health Access
2604/15/2023
Outcomes Services Coordination Incentives Measures
Core measures & NCQA standards provide a statewide framework PCMH payment model incents quality & coordination Community collaboratives guide quality & coordination initiatives More effective health services & community networks Health System (Accessible, Equitable, Patient Centered, Preventive, Affordable)
Community Oriented Health Systems
Department of Vermont Health Access
2704/15/2023
Blueprint Website:http://blueprintforhealth.vermont.gov/