Vermont Blueprint for Health

1
Vermont Blueprint for Health

• Sharon Moffatt
• Commissioner of Health
• August 2007

2
Sickest 10 Account for 64 of Health Care
Expenses
Expenditure threshold (2003
dollars)
1
5
24
10
36,280
49
12,046
64
50
6,992
97
715
Source The Commonwealth Fund. Data from S. H.
Zuvekas and J. W. Cohen, Prescription Drugs and
the Changing Concentration of Health Care
Expenditures, Health Affairs, Jan./Feb. 2007
26(1)24957.
3
Cost of Chronic Conditions is Both Personal and
Financial

• Care for people with chronic conditions accounts
  for
• 83 of health care spending
• 81 of hospital admissions
• 76 of all physician visits
• 91 of all prescriptions
• filled

4
Vermonters with Chronic Disease
5
The Cost of Obesity

• One-third of total direct health care costs in
  the U.S. are related to
• 15 Diseases Associated with Obesity
• Medical expenses attributable to
• Adult Obesity in Vermont
• 141 Million Annually

6
Chronic Disease and Obesity
7
Reducing diabetes deaths options
Deaths Per Thousand Adults
2.50
No Change
Better Care
2.25
Obesity Prevention
2.00
1.75
1.50
1.25
1980
1990
2000
2010
2020
2030
2040
2050
Time (Year)
8
Reducing diabetes deaths comprehensive approach
No Change
No major changes status quo
Care and reduction in caloric intake
Obesity Prevention and Better Care
1980
1990
2000
2010
2020
2030
2040
2050
Time (Year)
Deaths from complicationsper thousand Adults
9
The Model for Chronic Disease Care
10
Vermont Blueprint Model for Health
Blueprint Partnership
Community
Public Policy Public Health

• Built Environment
• Health Services
• Health Awareness
• Healthy Options
• Information
• Systems

Patients and Families
Healthy Vermonters

• Policies
• Infrastructure
• Financing
• Resources
• Advocacy
• Regulation
• Information
• Systems

• Health
• knowledge
• Self-manage-
• ment skills
• Supportive
• home
• environment
• Information
• Systems

Health Systems

• System policy
• Quality care
• Reimbursement
• Financing
• Continuity
• Coordination
• Information
• Systems

Health Provider Team

• Practice standards
• Office Systems
• Support
• Information
• Systems

11
Public Policy

• Governor Douglas has focused on investing in full
  System Approach
• Blueprint for Health
• Fit and Healthy Kids
• Drug Enforcement, Treatment, Education and
  Treatment (DETER )
• Catamount Health

12
Public Policy Legislation 2006 and 2007

• Full support of Governor Douglass Blueprint
  Budget
• Requires all private insurers, Medicaid and state
  employee health insurance to following Blueprint
  model
• Requires all clinical guidelines to be the same
  for all insurers

13
Provider Practice and Health Systems

• Best practice clinical standards for patient care
  
• Microsystems change at practice level
• Support the patient with connections to other
  parts of the health care system and the community
  
• Use e-health tools to link information and
  resources to the provider and patient

14
Information Technology

• Chronic Care Information System
• Supports medical decision making
• Clinical standards built in to guide the clinical
  care for individuals and targeted populations
• Provides reminders for recall visits
• Provides timely info from labs, specialties
• Emergency rooms will have immediate access to
  patients medications list

15
Healthy Living ParticipantsMedical Care

• Visits to a health care providers office and the
  Emergency Dept decreased significantly at 6 12
  months

MD Visits
ED Visits
16
Daily Activities

• Participants report, after 12 months, their
  health condition does not interfere with their
  daily activities such as social activities with
  friends, hobbies, recreational activities and
  household chores.

17
Community

• 53 of Vermont Adults are obese or overweight
• Communities have walking programs year round for
  all ages
• Farmers Markets have doubled in the last
• 5 years

18
Blueprint Budget 2006 By Focus Area
19
Best Practice Guidelines

• Agency for Healthcare Research and Quality
  www.guidelines.gov
• Institute for Clinical Systems Integration
  www.icsi.org
• American Diabetes Association www.diabetes.org
• American Heart Association www.americanheart.org

20
Resources/References

• The Chronic Care Model Improving chronic illness
  care a national program of The Robert Wood
  Johnson Foundation, www.improvingchroniccare.org
• Wagner, E.H. Chronic Disease Management What
  will it take to improve care for chronic illness?
  Effective Clinical Practice 1998
• 12-4.

21
Resources/References

• Crossing the Quality Chasm A New Health System
  for the 21st Centry, Institute of Medicine,
  National Academy of Sciences, 2001.
• To Err is Human Building a Safer Health System,
  Institute of Medicine, National Academy of
  Sciences, 2000.

22
Resources/References

• The Model for Improvement by the Institute for
  Health Improvement www.ihi.org
• The Quality of Health Care Delivered to Adults in
  the United States. New England Journal of
  Medicine 2003, 34826.
• Vermont Department of Health website
• www.healthvermont.gov