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Blueprint Integrated Pilot Programs

Blueprint Integrated Pilot Programs. Funding. Programs. Products. Blueprint Communities (Act 191, 2006). Clinical Transformation VPQ Coordinated Training Clinical Microsystems Provider Incentives Participation & Training Community Activation Local Programs Self Management

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Blueprint Integrated Pilot Programs

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  1. Blueprint Integrated Pilot Programs

  2. Funding Programs Products Blueprint Communities (Act 191, 2006) • Clinical Transformation VPQ Coordinated Training Clinical Microsystems • Provider Incentives Participation & Training • Community Activation Local Programs • Self Management Healthier Living Workshops • Health Information Technology VPQ Hosted Registry (VHR) • Evaluation VPQ Registry Reports VCHIP Chart Review • VITL Health Information Exchange Network • Improved Care Delivery (Diabetes) • IT enhanced care (Diabetes) • Improved self mgmt (HLW attendees) • Local exercise / prevention programs • VHR - Descriptive statistics (Diabetes) • VCHIP – Chart review • Blueprint Budget • Global Commitment • Catamount Fund • Federal Funds Sustainable Transformation Blueprint Medical Home Pilots (Act 71, 2007) • Advanced Medical Home • Improved Care Delivery (General) • Local care support & DM services • Sustainable Financial Reform • Improved Self Mgmt (Multi-faceted) • IT enhanced care -Chronic disease -Health maintenance -eRx • Prevention & Wellness Programs -Community team -Evidence based -Linked with care delivery • Payer Support • Medicaid • BCBS • Cigna • MVP • Local Care Support CCT • Financial Reform CCT support Provider Payment • Prevention Public Health Specialist on CCT Local Prevention Team • Health Information Technology VITL EMR Pilot Project VPQ Hosted Web Based CIS with eRx • VITL Health Information Exchange Network Grant Support • Evidence based healthcare process • Routine QA / QI • Evaluation of health impact • Evaluation of cost of care impact • Predictive modeling (claims / clinical) • Epidemiologic / outcomes research • CCT Utilization Patterns Evaluation Infrastructure • Multi payer claims data base • Clinical / demographic data base • Integrated data base • Peer Review Process

  3. Model for Health & Prevention PCMH • Payment reform • Comprehensive guideline based care • Health maintenance & prevention • Chronic conditions • Panel management • Coaching • Reminders • Goal setting • Health IT – planned visits • Health IT – population management • Health IT – eRx • Paper based or EMR practices • Primary Care PCMH • Docs • NPs • PAs • Staff CCT Support • Panel Management • Coaching • Patient / family contact • Assessment • Reinforce treatment plan • Education • Reminders • Self managementSocial / Economic Support • Liaison to other programs • Enrollment assistancePrevention & Self Management • Referral to community programs • Coordinate community programs Referrals, Communication & QI Planning Community Care Team (CCT) e.g. NP, RN, MSW, Dietician, Behavior Specialist, Community Health Worker, VDH Public Health Specialist Vermont Health Information Platform (VITL) Referral & care support Education & Improvement Public Health & Prevention

  4. Model for Health & Prevention Key points – BP plan to expand use of HIT • DocSite: Individualized visit planner (health maintenance & chronic disease) • DocSite: Sophisticated reporting that supports population management • DocSite: Electronic prescribing • DocSite: Works with an EMR or as stand alone care support system • EMRs: Broader scope of functionality (at the individual patient level!!!) • EMRs & DocSite have COMPLIMENTARY clinical functions • Registries such as DocSite can be an extension of an EMR (a module) • HIE should support the FULL RANGE of clinical scenarios • Practices and providers will adapt to best fit

  5. Model for Health & Prevention Examples of how clinical work flow can vary - supported by complimentary health IT products • All practice & CCT personnel use EMR for all data entry and care support(1 way data exchange to DocSite - data to be used to evaluate program) • Practice & CCT personnel use EMR for all data entry and use DocSite for population reports (Requires 1 way data exchange to DocSite) • Practice personnel use EMR for all data entry. CCT uses DocSIte for data entry and population reports (2 way data exchange) • Practice personnel use EMR for all data entry and use DocSite visit planner to help guide visit. CCT uses DocSIte for data entry and population reports(2 way data exchange) • Most practice personnel use EMR for data entry. The staff that are doing the intake assessment use survey and risk assessments in DocSite, enter vital signs in DocSite, and generate visit planner (2 way data exchange)

  6. Policies and Systems Local, state, and federal policies and laws, economic and cultural influences, media Community Physical, social and cultural environment Organizations Schools, worksites, faith-based organizations, etc Relationships Family, peers, social networks, associations Individual Knowledge, attitudes, beliefs Adapted from: McElroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Education Quarterly 15:351-377, 1988. Model for Health & Prevention Referrals & Communication Hospital -Educators -Transitional care -Ambulatory center (wellness programs) • Primary Care PCMH • Docs • NPs • Staff Community Care Team (CCT) e.g. NP, RN, MSW, Dietician, Behavior Specialist, Community Health Worker, VDH Public Health Specialist Support for evidence based public health, prevention, & policy Vermont Health Information Platform (VITL) Referral & care support Education & Improvement Public Health & Prevention

  7. St. Johnsbury Family HC Chronic Care Coor .5 FTE Beh. Health Spec. .5 FTE Primary Care Practices VDH District Office Public Health Specialist Ladies First Coordinator. Calodenia Int. Medicine Chronic Care Cood .5 FTE Beh. Health Spec. .5 FTE St. Johnsbury Community Care Team Concord Health Ctr. Chronic Care Cood .5 FTE Beh. Health Spec. .5 FTE Community Connections Community Health Workers CC Comm. Health Worker Danville Health Center Chronic Care Coor .5 FTE Beh. Health Spec .5 FTE Other OVHA Care Managers Hospital Care Managers Hospital-based CC Educators Community-based Advocates Corner Medical Chronic Care Coor 1 FTE Beh. Health Spec 1 FTE

  8. BLUEPRINT PILOT PROGRAM Plan For Program Evaluation & Improvement Performance Measure Relevant to objective Objective Analysis & Review Achieve objective? Modify of Healthcare Process Modify Measures & Methods

  9. The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. There are nine PPC standards, including 10 must pass elements, which can result in one of three levels of recognition.  Practices seeking PPC- PCMH complete a Web-based data collection tool and provide documentation that validates responses.

  10. Standards

  11. NCQA PCMH Scoring Level 2 Level 3 Level 1 NR NCQA Level Points Must Pass 0-24 NR 25-49 50-74 75-100 <5 5 of 10 10 of 10 10 of 10 0 20 40 60 80 100

  12. Proposed Model for Provider Payment Level 2 Level 3 Level 1 NR NCQA Level Points Must Pass 0-24 NR 25-49 50-74 75-100 <5 5 of 10 10 of 10 10 of 10 0 20 40 60 80 100

  13. Provider Payment Table ($PPPM for each provider) Requires 5 of 10 must pass elements Requires 10 of 10 must pass elements

  14. NCQA Scoring & Provider Payment 5 of 10 MP 10 of 10 MP

  15. Practice Evaluation & Quality Improvement VPQ (current) • Clinical Microsystems Training • VHR • DocSite VCHIP (current) • Chart Review • ACIC (readiness) • Focus Groups VPQ (proposed) • Use reports • Guide Microsystems Training • Guide QA / QI planning • Focused on NCQA PCMH Stds VCHIP (proposed) • Review against NCQA standards • Onsite Review • Analysis of DocSite data • Report based on NCQA scoring Ongoing QA / QI Payment

  16. Practice Evaluation & Payment Model 6 months 30 days 30 days VCHIP Report VCHIP Report NCQA Review NCQA Review Adjust Payment • Retroactive to 6 month interval date • $ PPPM calculation -refreshed NCQA score -refreshed active patient panel • Active patient panel (attribution) -visit <12 months to practice PCP -eligibility check • Paid quarterly vs. monthly Start Payment • Retroactive to index date • $ PPPM calculation -initial NCQA score -active patient panel • Active patient panel (attribution) -visit <12 months to practice PCP -eligibility check • Paid quarterly vs. monthly

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