Blueprint Integrated Pilot Programs Building an Integrated System of Health

Transcription

1 Blueprint Integrated Pilot Programs Building an Integrated System of Health Craig Jones, MD Blueprint Executive Director 6/3/2010 1

2 Office of Healthcare Reform Office of Vermont Health Access 312 Hurricane Lane Suite 201 Williston, VT Vermont Blueprint for Health Department of Health 108 Cherry Street Suite 301 PO Box 70 Burlington, VT Susan W. Besio, Ph.D. Director Office of Vermont Health Access Vermont Health Care Reform Hunt Blair Deputy Director Healthcare Reform (802) Diane Hawkins Executive Staff Assistant (802) Craig Jones, MD Blueprint Executive Director (802) phone (802) fax Lisa Dulsky Watkins, MD Blueprint Assistant Director (802) phone (802) fax Jenney Samuelson, MS Blueprint Community & Self Management Director (802) phone (802) fax James Morgan, MSW Blueprint Project Administrator (802) phone (802) fax Terri Price Blueprint Administrative Support Healthier Living Workshop Statewide Coordinator (802) phone (802) fax Diane Hawkins Executive Staff Assistant Office of Health Care Reform 312 Hurricane Lane Williston, VT (802) /3/2010 2

3 Vermont's healthcare reforms include: Universal coverage A primary care foundation (PCMHs + CHTs) Multi-Insurer Payment Reforms A focus on prevention (public health health care delivery) A statewide health information exchange An evaluation infrastructure to support ongoing improvement Facilitators & support for a learning health system

4 Specialty Care & Disease Management Programs Hospitals A foundation of medical homes and community health teams that can support coordinated care and linkages with a broad range of services Social, Economic, & Community Services Mental Health & stance Abuse Programs Healthier Living Workshops Community Health Team Nurse Coordinator Social Workers Nutrition Specialists Community Health Workers MCAID Care Coordinators Public Health Specialist Public Health Programs & Services Health IT Framework Evaluation Framework 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 6/3/2010 4

5 NCQA PCMH Points Average PPPM Payment /3/2010 5

6 $ PPPM per provider $3.00 $2.50 $2.00 $1.50 $1.00 $0.50 $0.00 Requires 5 of 10 Must Pass Elements NCQA PCMH Score Requires 5 of 10 Must Pass Elements All insurers pay enhanced payment based on a practices score as a patient centered medical home NCQA PCMH standards and scoring methods are used to score practices as a medical home Payment changes with each 5 point change in the NCQA PCMH score (score ranges from points) Designed to incent ongoing iterative improvement, and to provide a disincentive for moving backwards 6/3/2010 6

7 Advanced Model of Primary Care A Foundation for integrated services AMPC Foundation Community Health Team Patient Centered s Multi-insurer payment reform Health Information Infrastructure Evaluation Infrastructure General population

8 Advanced Model of Primary Care A Foundation for integrated services Guideline based care Tools (e.g. HRAs) Targeted Interventions Best Practices AMPC Foundation Community Health Team Patient Centered s Multi-insurer payment reform Health Information Infrastructure Evaluation Infrastructure General population

9 Advanced Model of Primary Care A Foundation for integrated services Targeted Services Economic Services Social Services Case Management Disease Management Programs Specialty Care AMPC Foundation Community Health Team Patient Centered s Multi-insurer payment reform Health Information Infrastructure Evaluation Infrastructure General population

10 Advanced Model of Primary Care A Foundation for integrated services Targeted Services Economic Services Social Services Case Management Disease Management Programs Specialty Care AMPC Foundation Community Health Team Patient Centered s Multi-insurer payment reform Health Information Infrastructure Evaluation Infrastructure General population

11 Advanced Model of Primary Care A Foundation for integrated services Targeted Services Economic Services Social Services Case Management Disease Management Programs Specialty Care Areas of Focus Family Wellness & Children's Services Mental Health & stance Use Medicaid Care Coordination Senior Services (SASH) Disease Specific (CHF) AMPC Foundation Community Health Team Patient Centered s Multi-insurer payment reform Health Information Infrastructure Evaluation Infrastructure Steps Financial Impact Model Clinical Services Model Payment Reforms IT Infrastructure & Enhancements Implementation Plan Evaluation Plan

12 Blueprint Integrated Pilots Health Information Infrastructure Hospital (hosted EMR) data warehouse Partner Hospitals (EMR network) Core data elements VITL HIE FQHC (hosted EMR) EMR Core data elements Core data elements Core data elements Other Registries (e.g. Immunization) Central Clinical Registry (DocSite) EMR Core data elements Web Access Functions of a Central Registry Visit planners (individual patient care) Care coordination Reporting (panel management, outreach) Tracking for public health services Reporting for public health planning Reporting & comparative benchmarks Web Access Community Health Team 6/3/2010 No EMR 12

13 Evaluation & Reporting (Data sources) Electronic Records Centralized Clinical Registry Multi-insurer claims data base Public Health Registries Chart Reviews NCQA Scoring

14 Blueprint Integrated Pilots Evidence Based Quality Improvement Data Source Data Processing & Storage Data Analysis Data Reports & Uses EMRs used for Individual Patient Care EMR Databases Data transmission & transformation VITL / GE EMR Reporting Tool or Analyst Clinical Process Measures Individual Patient Care & Support Services DocSite used for Individual Patient Care DocSite Database DocSite Reporting Tool Health Status Measures Management Integrated Health Informatics Platform Healthcare Quality Measures & Standards Quality Improvement Claims from Commercial Insurers & Medicaid BISCHA Multipayer Database BISCHA Reports Healthcare Patterns & Resource Utilization Provider Payment for Quality VCHIP Chart Review & NCQA Scoring VCHIP Databases VCHIP Analysis & Report Generation Healthcare Expenditures & Financial Impact Program Evaluation & Sustainability Public Health Surveys & Data Collection Public Health Registries & Databases VDH Health Surveillance Analytic Database VDH Health Surveillance Analyst Indicators & Risk Factors Community Prevention Planning 6/3/

15 Target % of VT # CHTs 42, % 2 126,286 20% 6 316,662 50% ,17 80% , % 32 6/3/

16 Target 42, , , ,17 637,130 % of VT 6.7% 20% 50% 80% 100% 6/3/2010 # CHTs

17 Pilot Locations thru July 2010

18 Building Local Enhancement & Assistance Capacity Facilitator Competencies Assessments Facilitation Negotiation Team Approach Process Improvement Using Data to Drive Change Goal Setting & Tracking Critical Thinking Systems Thinking Supportive

19 Blueprint model includes: PCMHs & interdisciplinary teams Systems based coordinated health services A population to practice focus on prevention Health informatics & evaluation infrastructure Learning health system Interdisciplinary education

20 Teams embedded in the model: Practice Based Teams (care delivery, QI) Community Health Team (core) Community Health Team (functional) Facilitation & Implementation Team (coaches) Interdisciplinary Evaluation Team State Leadership, Strategic Planning & Policy Team 20

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