Department of Vermont
Health Access
Vermont Blueprint for Health:
Using APCD to Evaluate
Health Care Reform
Pat Jones, MS
Blueprint Assistant Director
Department of Vermont Health Access
National APCD Conference
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October 25, 2012
Department of Vermont
Health Access
The Vermont Blueprint for Health:
Building A Foundation For The Future
 Advanced Primary Care Practices (Patient Centered
Medical Homes)
 Community Health Teams (core and extended)
 Multi-insurer Payment Reforms
 Health Information Infrastructure
 Evaluation and Reporting Systems
 Learning Health System Activities
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Department of Vermont
Health Access
Hospitals
Advanced
Primary
Care
Specialty Care & Disease
Management Programs
Social, Economic, &
Community Services
 A foundation of medical homes and
Community Health Team
Nurse Coordinator
Social Workers
Nutrition Specialists
Community Health Workers
Public Health Specialist
Advanced
Primary
Care
Advanced
Extended Community Health Team
Primary
Medicaid Care Coordinators
Care
Medicare “Support and Services
at Home” Teams
Advanced
Addiction Teams
Primary
Healthier Living
Care
Workshops
Mental Health &
Substance Abuse
Programs
Public Health
Programs & Services
Health IT Framework
Evaluation Framework
Multi-Insurer Payment Reform Framework
community health teams that can
support coordinated care and linkages
with a broad range of services
 Multi-insurer payment reform that
supports this 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
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Department of Vermont
Health Access
Data Sources & Evaluation
 Central Clinical Registry
 Multi-payer Claims Database
 Chart Reviews
 NCQA Scoring
 Public Health Registries
 Patient Provider Qualitative Assessment
 Patient Experience
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Department of Vermont
Health Access
How does the Blueprint
use VHCURES for evaluation?
• Used for evaluation, financial modeling, practice profiles, special
studies
• Compares Blueprint participants and controls
• Expenditure measures (e.g., inpatient, ED, professional,
pharmacy, mental health)
• Utilization measures (e.g., inpatient discharges, ambulatory care
sensitive conditions, readmissions, preventable ED visits,
advanced imaging, medical and surgical specialty care)
• HEDIS® effective and preventive care measures (e.g., breast
cancer screening, well child visits)
• Measures are evaluated separately for members with seven
targeted chronic conditions (diabetes, asthma, COPD,
hypertension, CHF, coronary heart disease, depression)
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Department of Vermont
Health Access
Example of Utilization Reporting
Source: Analysis by Onpoint Health Data for 2011 Blueprint Annual Report
Outpatient ED Visits
170.9
170
Inpatient Discharges
44.0
+10%
165
161.8
160
-1%
160.7
155
154.9
150
2007
Participants
2010
Comparison Group
Inpatient Discharge Rate Per 1,000
Outpatient ED Visit Rate Per 1,000
175
43.5
43.4
43.0
42.5
42.5
-1%
42.3
42.0
-6%
41.5
41.0
40.8
40.5
40.0
2007
Participants
2010
Comparison Group
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Department of Vermont
Health Access
Example of Expenditure Reporting
Source: Analysis by Onpoint Health Data for 2011 Blueprint Annual Report
Outpatient ED Expenditures per Capita
$190
$185.00
$180
$172.00
$170
Inpatient Expenditures per Capita
$750
$160
+56%
$150
$707.00
+50%
$700
$702.00
$140
$650
$130
$119.00
$120
+41%
$600
$115.00
$110
2007
Participants
+50%
2010
$550
Comparison Group
$500
$500.00
$470.00
$450
2007
Participants
2010
Comparison Group
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Department of Vermont
Health Access
Practice Profiling Template
Source: Sample Data from 20 Blueprint Practices
Outpatient ED Visits
Outpatient ED Visits
400
350
Adjusted Rate Per 1,000
300
250
Lower Confidence Limit
200
Adjusted Rate
Upper Confidence Limit
150
100
50
0
Practice
PJ PB PL PN PH PD PG PI PP PM PK PR PO PC PT PF PS PQ PE
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