1. Blueprint Integrated Pilot Programs Building an Integrated System of Health Craig Jones, MD Blueprint Executive Director craig.jones@ahs.state.vt.us 2/10/20141 Congressional Briefing December 13, 2010 Alliance for Health Reform & Commonwealth Fund

2. Coverage equals Coverage Coverage does not equal: Reliable access High quality health services Better control over healthcare costs Improved patient experience Need reforms that lead to coordinated health services with a focus on prevention & wellness

3. Vermont's Reforms Include: Universal coverage Advanced Primary Care foundation (PCMHs + CHTs) Multi-Insurer Payment Reforms A statewide health information exchange An evaluation infrastructure to support ongoing improvement Facilitators & support for a learning health system

4. Vermont Blueprint Context Dedicated leadership Guiding Legislation History of working together Improve quality & control of costs Focus on prevention & wellness 13 Hospitals & Service Areas 3 major commercial insurers, Medicaid, Medicare

5. Health IT Framework Evaluation Framework Medical Home Hospitals Public Health Programs & Services Community Health Team Nurse Coordinator Social Workers Nutrition Specialists Community Health Workers MCAID 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 Social, Economic, & Community Services Healthier Living Workshops 2/10/20145

6. Multi-insurer Payment Reforms Insurers Community Health Teams Shared costs as 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 $1.20 - $2.49 PPPM Based on active case load 5 FTE / 20,000 people $ 350,000 per 5 FTE Scaled based on population Medicaid Commercial Insurers Medicare?

7. Building a Learning Health System State Policy & leadership Strategic planning Coordination IT Infrastructure Central Registry Multi-payer database University of Vermont NCQA scoring Chart review Analytics Reporting Informatics platform Multi-disciplinary expertise Web based reporting platforms Multi-disciplinary study teams Comparative effectiveness & evaluation PracticesCommunity Health Teams HospitalsOther Services & Providers Coaching & Facilitation Team (Blueprint & University of Vermont)

9. 9 Federal Agencies & Programs CMSClinical Models Financial Reforms Payment Reforms ONCHealth Information Infrastructure Expand use of Electronic Health Records CDCPublic Health Prevention AHRQEvaluation Quality Improvement Best Practices & Implementation HRSAHealth Centers Rural Health National Health Service & Workforce National InstitutesEvidence Based Guidelines Research & Evaluation IOMFramework for a Learning Health System Design Principles & Goals State & Federal Partnerships Building a preventive health services model State Led Health Reform Systemness in a Non-System Financial & Payment Reforms Advanced Primary Care Practices Care Support Coordinated Services Guideline Based Care Focus on Prevention Health Information Infrastructure Evaluation & QI Infrastructure Learning Health System