Blueprint Integrated Pilot Programs Building an Advanced Model of Primary Care

(1)

Blueprint Integrated Pilot Programs

Building an Advanced Model of Primary Care

(2)

Craig Jones, MD

Blueprint Executive Director

(802) 879-5988 phone

(802) 859-3007 fax

James Morgan, MSW

Blueprint Project Administrator

(802) 865-7795 phone

(802) 859-3007 fax

Blueprint Team

Vermont Department of Health

108 Cherry Street – Suite 301

PO Box 70

Burlington, VT 05402

Office of Healthcare Reform

Office of Vermont Health Access

Vermont Health Care Reform

312 Hurricane Lane, Suite 201

Williston, VT 05495

Susan W. Besio, Ph.D.

Director

Office of Vermont Health Access

Vermont Health Care Reform

802-879-5901

Lisa Dulsky Watkins, MD

Blueprint Assistant Director

(802) 652-2095 phone

(802) 859-3007 fax

Jenney Samuelson, MS

Blueprint Community &

Self Management Director

(802) 863-7204 phone

(802) 859-3007 fax

Terri Price

Blueprint Administrative Support

Healthier Living Workshop

Statewide Coordinator

(802) 652-2096 phone

(802) 859-3007 fax

Diane Hawkins

Executive Staff Assistant

Office of Health Care Reform

312 Hurricane Lane

Williston, VT 05495

(802) 879-5988

802-879-5901

Hunt Blair

Deputy Director

Healthcare Reform

(802) 879-5901

Diane Hawkins

Executive Staff Assistant

(802) 879-5988

(3)

Blueprint Integrated Pilots

Coordinated Health System

PCMH

Hospitals

Community Health Team

Nurse Coordinator

Social Workers

Dieticians

Community Health Workers

OVHA Care Coordinators

Mental Health

& Substance

Use Disorders

Health IT Framework

Global Information Framework

Evaluation Framework

Operations

PCMH

Public Health Prevention

OVHA Care Coordinators

Public Health Prevention Specialist

(4)

Blueprint Integrated Pilot Summary

1. Financial reform (2 major components - includes MCAID & commercial insurers)

- Payment to practices based on NCQA PCMH score

- Shared costs for Community Care Teams

2. Multidisciplinary care support teams (CCT Teams)

- Local care support & population management

3. Health Information Technology

- Web based clinical tracking system (DocSite)

- Visit planners & population reports

- Electronic prescribing

- Updated EMRs to match program goals and clinical measures in DocSite

- Health information exchange network

4. Community Activation & Prevention

- Prevention specialist as part of CCT

- Community profiles & risk assessments

- Evidence based interventions

5. Evaluation

- NCQA PCMH score (process quality)

- Clinical process measures

- Health status measures

- Multi payer claims data base

- Population Indicators

(5)

Health Status Measures Clinical Process Measures Population Management Individual Patient

Care & Support Services

Data

Processing & Storage

EMRs used for Individual Patient

Care

DocSite used for Individual Patient Care DocSite Database EMR Databases DocSite Reporting Tool

Data

Source

Data transmission & transformation

VITL / GE

Data

Analysis

Data

Reports & Uses

EMR Reporting Tool or

Analyst

Blueprint Integrated Pilots

Evidence Based Quality Improvement

Healthcare Patterns & Resource Utilization Healthcare Expenditures & Financial Impact Population Indicators & Risk Factors Healthcare Quality Measures & Standards Quality Improvement Program Evaluation & Sustainability Community Prevention Planning Provider Payment for Quality VCHIP Chart Review &

NCQA Scoring Medical Claims from

Commercial Insurers & Medicaid

Public Health Surveys & Data

Collection Public Health Registries & Databases VDH Health Surveillance Analytic Database BISCHA Multipayer Database VCHIP Databases VCHIP Analysis & Report

Generation BISCHA Reports VDH Health Surveillance Analyst Contracted Analysis Services

(6)

Population Management Individual Patient

Data

Processing & Storage

Care

Data

Source

VITL / GE

Data

Analysis

Data

Reports & Uses

EMR Reporting Tool or Analyst Health Status Measures Clinical Process Measures

Blueprint Integrated Pilots

Evidence Based Quality Improvement

Quality Improvement Program Evaluation & Sustainability VCHIP

Chart Review & NCQA Scoring Medical Claims from

Generation BISCHA Reports Healthcare Patterns & Resource Utilization Healthcare Expenditures & Financial Impact VDH Health Surveillance Analyst Population Indicators & Risk Factors Contracted Analysis Services Community Prevention Planning Healthcare Quality Measures & Standards Provider Payment for Quality

(7)

Data

Processing & Storage

Care

DocSite used for Individual Patient Care DocSite Database EMR Databases DocSite Reporting Tool Population Management

Data

Source

VITL / GE

Data

Analysis

Data

Reports & Uses

EMR Reporting Tool or Analyst Health Status Measures Clinical Process Measures Individual Patient Care & Support

Services

Blueprint Integrated Pilots

Evidence Based Quality Improvement

Quality Improvement Program Evaluation & Sustainability VCHIP

Chart Review & NCQA Scoring Medical Claims from

Generation BISCHA Reports Healthcare Patterns & Resource Utilization Healthcare Expenditures & Financial Impact VDH Health Surveillance Analyst Population Indicators & Risk Factors Contracted Analysis Services Community Prevention Planning Healthcare Quality Measures & Standards Provider Payment for Quality

(8)

Data

Processing & Storage

Care

DocSite used for Individual Patient Care DocSite Database EMR Databases DocSite Reporting Tool Population Management

Data

Source

VITL / GE

Data

Analysis

Data

Reports & Uses

EMR Reporting Tool or Analyst Health Status Measures Clinical Process Measures Individual Patient Care & Support

Services

Blueprint Integrated Pilots

Evidence Based Quality Improvement

Program Evaluation & Sustainability Contracted Analysis Services Quality Improvement VCHIP Chart Review &

NCQA Scoring

Medical Claims from Commercial Insurers & Medicaid

Generation BISCHA Reports Healthcare Patterns & Resource Utilization Healthcare Expenditures & Financial Impact VDH Health Surveillance Analyst Population Indicators & Risk Factors Community Prevention Planning Healthcare Quality Measures & Standards Provider Payment for Quality

(9)

Blueprint Integrated Pilots

Financial Impact

$340,000,000

$360,000,000

$380,000,000

$400,000,000

$420,000,000

IN

C

R

E

M

E

N

T

A

L

C

O

S

T

P

E

R

Y

E

A

R

IMPACT OF MEDICAL HOME

SAVINGS ACROSS TOTAL POPULATION

INCREMENTAL EXPENDITURES WITHOUT MEDICAL HOMES INCREMENTAL EXPENDITURES WITH MEDICAL HOMES

2009

2010

2011

2012

2013

Percentage of Vermont

population participating

6.7%

9.8%

13.0%

20.0%

40.0%

Participating population

42,179

61,880

82,332 127,045

254,852

# Community Care Teams

2

3

4

6

13 $300,000,000

$320,000,000

$340,000,000

1

2

3

4

5 IN

C

R

E

M

E

N

T

A

L

C

O

S

T

P

E

R

Y

E

A

R

YEARS

(10)

Health Status Measures Clinical Process Measures Population Management Individual Patient

Data

Processing & Storage

Care

Data

Source

VITL / GE

Data

Analysis

Data

Reports & Uses

EMR Reporting Tool or

Analyst

Blueprint Integrated Pilots

Evidence Based Quality Improvement

VDH Health Surveillance Analytic Database Healthcare Patterns & Resource Utilization Healthcare Expenditures & Financial Impact Healthcare Quality Measures & Standards Quality Improvement Program Evaluation & Sustainability Community Prevention Planning Provider Payment for Quality VCHIP Chart Review &

NCQA Scoring

Medical Claims from Commercial Insurers & Medicaid

BISCHA Multipayer Database VCHIP Databases VCHIP Analysis & Report

Generation BISCHA Reports VDH Health Surveillance Analyst UVM CCTS Health Informatics Platform Population Indicators & Risk Factors Public Health Surveys & Data

Collection Public Health Registries & Databases VDH Health Surveillance Analyst

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HIPPA Compliant

Environment

 Storage

Normalization

De-identification

Central

Repository

De-Identified

Data

High Performance

Computing Center

Processing

DocSite

Clinical Data

PHI

De-identification

Re-identification

Analytics (Routine)

Analytics (Exploratory)

Workbench

Reporting

Data

_{Processing}

Query for experiments

Data Sources

Transmission

UVM CCTS Health Informatics Platform

Multipayor

(12)

HIPPA Compliant

Environment

 Storage

Central

Repository

De-Identified

High Performance

Computing Center

State # 1

claims data

_{assigned identifier}

Encrypted or

State # 2

claims data

_{assigned identifier}

Encrypted or

State # 3

_{Encrypted or}

Routine Comparative

Effectiveness Reporting

 Storage

Normalization

De-identification

Re-identification

Analytics (Routine)

Analytics (Exploratory)

Workbench

Reporting

Identified

Data

_{Processing}

Query for experiments

Data Sources

Transmission

UVM CCTS Health Informatics Platform

State # 3

claims data

_{assigned identifier}

Encrypted or

State # 4

claims data

_{assigned identifier}

Encrypted or

State # 5

(13)

Build a multidimensional evaluation framework



Support patient care & population management



Support ongoing quality improvement

Blueprint Integrated Pilots

Building a Scalable Model



Support ongoing quality improvement



Evaluate trends in clinical outcomes



Evaluate trends of financial impact