vermont blueprint for health sharon moffatt commissioner of health august 2007
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Vermont Blueprint for Health
Sharon Moffatt
Commissioner of Health
August 2007
0%
10%
20%30%
40%
50%
60%
70%80%
90%
100%
U.S. Population Health Expenditures
Sickest 10 % Account for 64 % of Health Care Expenses
1%5%
10%
49%
64%
24%
Source: The Commonwealth Fund. Data from S. H. Zuvekas and J. W. Cohen, “Prescription Drugs and the Changing Concentration of Health Care Expenditures,” Health Affairs, Jan./Feb. 2007 26(1):249–57.
50%
97%
$36,280
$12,046
$6,992
$715
Expenditure threshold (2003 dollars)
Cost of Chronic Conditions is Both Personal and Financial
Care for people with chronic conditions accounts for83% of health care spending81% of hospital admissions76% of all physician visits91% of all prescriptions filled
Vermonters with Chronic Disease
Percent of Vermont Adults with Chronic Diseases
2001
0%10%20%30%40%50%60%70%80%90%
100%
None 1 or more 2 or more 3 or more 4 or more
all ages 65+
The Cost of ObesityOne-third of total direct health care costs in
the U.S. are related to
15 Diseases Associated with Obesity
Medical expenses attributable to
Adult Obesity in Vermont
141 Million Annually
Vermont Adults Reporting Chronic Conditions by Body Mass Index
0
10
20
30
40
50
Non-gestational diabetes Ever had cardiovascular disease Arthritis
Healthy weight Overweight Class III ObeseSource: Vermont Behavioral Risk Factor Surveillance System 2001
Chronic Disease and Obesity
Deaths Per Thousand Adults
2.50
2.25
2.00
1.75
1.50
1.25
1980 1990
2000
2010
2020
2030
2040
2050Time (Year)
No Change
Obesity Prevention
Better Care
Reducing diabetes deaths: options
Deaths from complications–per thousand Adults
No major changes – status quo
Care and reduction in caloric intake
2.50
2.25
2.00
1.75
1.50
1.25
1980 1990 2000 2010 2020 2030 2040 2050
Time (Year)
Obesity Prevention and Better Care
No Change
Reducing diabetes deaths: comprehensive approach
The Model for Chronic Disease Care
Vermont Blueprint Model for Health
HealthyVermonters
Patients and Families
Community
HealthProvider Team
•Practice standards•Office Systems•Support•Information Systems
•Built Environment•Health Services•Health Awareness•Healthy Options•Information Systems
Health Systems
Public PolicyPublic Health
•System policy•Quality care•Reimbursement•Financing•Continuity•Coordination•Information Systems
•Policies•Infrastructure•Financing•Resources•Advocacy•Regulation•Information Systems
•Health knowledge•Self-manage- ment skills•Supportive home environmentInformation Systems
Blueprint Partnership
Public Policy
Governor Douglas has focused on investing in full System Approach
Blueprint for Health Fit and Healthy KidsDrug Enforcement, Treatment, Education
and Treatment (DETER )Catamount Health
Public Policy Legislation 2006 and 2007
Full support of Governor Douglas’s Blueprint Budget
Requires all private insurers, Medicaid and state employee health insurance to following Blueprint model
Requires all clinical guidelines to be the same for all insurers
Provider Practice and Health Systems
Best practice clinical standards for patient care
Microsystems change at practice levelSupport the patient with connections to
other parts of the health care system and the community
Use e-health tools to link information and resources to the provider and patient
Information Technology
Chronic Care Information System Supports medical decision making: Clinical standards built in to guide the clinical
care for individuals and targeted populations Provides reminders for recall visits Provides timely info from labs, specialties Emergency rooms will have immediate access to
patients’ medications list
Healthy Living ParticipantsMedical Care
6.7
5.3
3.8
Baseline 6 Months 12 Months
0.56
0.430.38
Baseline 6 Months 12 Months
MD Visits ED Visits
Visits to a health care provider’s office and the Emergency Dept decreased significantly at 6 & 12 months
Daily Activities Participants report, after 12 months, their health condition does
not interfere with their daily activities such as social activities with friends, hobbies, recreational activities and household chores.
54%
33%38%
60%53% 55%
Does Not Interfere With Normal SocialActivities
Does Not Interfere With Hobbies/RecActivities
Does Not Interfere With HouseholdChores
0 month 12 month
Community
53% of Vermont Adults are obese or overweight
Communities have walking programs year round for all ages
Farmers’ Markets have doubled in the last
5 years
Community9%
Self Management
9%
Provider Practice
9%
Clinical Registry System
66%
Health Systems7%
Blueprint Budget 2006 By Focus Area
Best Practice Guidelines
Agency for Healthcare Research and Quality www.guidelines.gov
Institute for Clinical Systems Integration www.icsi.org
American Diabetes Association www.diabetes.org
American Heart Association www.americanheart.org
Resources/References
The Chronic Care Model: Improving chronic illness care a national program of The Robert Wood Johnson Foundation, www.improvingchroniccare.org
Wagner, E.H. Chronic Disease Management: What will it take to improve care for chronic illness? Effective Clinical Practice 1998;
12-4.
Resources/References
Crossing the Quality Chasm: A New Health System for the 21st Centry, Institute of Medicine, National Academy of Sciences, 2001.
To Err is Human: Building a Safer Health System, Institute of Medicine, National Academy of Sciences, 2000.
Resources/ReferencesThe Model for Improvement by the
Institute for Health Improvement www.ihi.org
The Quality of Health Care Delivered to Adults in the United States. New England Journal of Medicine 2003, 348:26.
Vermont Department of Health website:
www.healthvermont.gov