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Vermont Health Resource Allocation Plan HRAP Prepared for Vermont Health Care Summit Advancing Workf

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Page 2. Act 53: Statutory Background of the HRAP ... Betty Rambur, DNSc, R.N. - Dean, Professor, UVM College of Nursing & Health Sciences ... – PowerPoint PPT presentation

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Title: Vermont Health Resource Allocation Plan HRAP Prepared for Vermont Health Care Summit Advancing Workf


1
VermontHealth Resource Allocation Plan
(HRAP)Prepared for Vermont Health Care Summit
Advancing Workforce Economic Solutions Stowe,
Vermont June 2, 2005byPaulette Thabault,
Deputy CommissionerVermont Department of
Banking, Securities, Insurance and Health Care
Administration
2
Act 53 Statutory Background of the HRAP
  • Purpose of Act 53 - passed by Vermont
    Legislature in 2003
  • Strengthen the health planning process.
  • Assist consumers in making decisions by providing
    accessible, useful information comparing cost and
    performance.
  • Develop a health resource allocation plan to
    guide health facility planning, capital
    expenditures, and budget reviews.
  • Create efficient and effective regulatory system
    capable of achieving Vermonts health care cost
    containment and other health care policy goals.
  • Open dialogue between hospitals and their
    communities.
  • Increase opportunities for public involvement in
    health policy planning.

3
Act 53 Statutory Background of the HRAP
  • HRAP Requirements under Act 53
  • Commissioner of Vermont Division of Banking,
    Insurance, Securities and Health Care
    Administration (BISHCA) to prepare a four-year
    Health Resource Allocation Plan (HRAP) to
    submitted to the Governor on or before July 1,
    2005.
  • Each hospital must conduct four-year community
    needs assessments to identify and prioritize the
    health care needs of the community, and publish
    hospital community reports, which include
    measures of
  • Quality
  • Patient Safety
  • Financial Health
  • Costs

4
Conceptual Framework of the HRAP
  • The HRAP must
  • Identify Vermont needs regarding health care
    services, programs and facilities.
  • Identify the resources available to meet
    identified needs.
  • Identify the priorities for addressing needs on a
    statewide basis.
  • The HRAP includes
  • Statement of Principles
  • Current supply and distribution of services
  • Recommendation for appropriate supply and
    distribution of services, including
    implementation options
  • Benchmarks wherever possible
  • Specific Health Services Addressed by the HRAP

Hospital Services Nursing Home Services
Home Health Services Mental Health Services
Substance Abuse Services Emergency Care
Ambulatory Care Major Medical Equipment
5
Conceptual Framework of the HRAP
  • The Commissioner of BISHCA established the HRAP
    Advisory Committee with diverse perspectives on
    health care to review drafts and provide
    recommendations during development.
  • Current Members
  • Health Care Professionals
  • J. Churchill Hindes - CEO, VNA of Chittenden
    Grand Isle Counties
  • David Little, M.D. - Medical Director, UVM AHEC
    Program
  • Stephen Marion - Vice President, Regional
    Planning, Dartmouth-Hitchcock Alliance
  • Madeleine Mongan - Vice President, Policy,
    Vermont Medical Society
  • Betty Rambur, DNSc, R.N. - Dean, Professor, UVM
    College of Nursing Health Sciences
  • David Reynolds - Executive Director, Northern
    Counties Health Care
  • Harvey Yorke - President CEO, Southwestern
    Vermont Health Care

6
Conceptual Framework of the HRAP
  • Current Members (cont.)
  • Consumer Representatives
  • John Nopper - Owner, River View Farm
  • Patricia Burnham - Consultant, Transitions
    Associates
  • Public Oversight Commission
  • Greg Peters - Managing Partner, Lake Champlain
    Capital Management, LLC
  • John O'Kane - Manager, Community Government
    Relations, IBM Corporation
  • Health Care Payer
  • Michael McCormack, CPA - McCormack, Guyette
    Associates
  • Third Party Payer
  • Catherine Hamilton, Ph.D - Vice President,
    Planning, BCBSVT

7
Guiding Principles of the HRAP
  • In accordance with the established principles,
    the Vermont Health Care System will be
  • Safe by identifying strategies and implementing
    mechanisms to avoid injuries to patients from the
    care that is intended to help them and to
    provider staff from the environment that is
    intended to support them.
  • Effective by identifying strategies and
    implementing mechanisms to provide services based
    on scientific knowledge to all who could benefit
    and refraining from providing services to those
    not likely to benefit.
  • Patient Centered by identifying strategies and
    implementing mechanisms for provision of care
    that is respectful of and responsive to
    individual patient preferences, needs, and values
    and for ensuring that patient values guide all
    clinical decisions.
  • Timely by identifying strategies and implementing
    mechanisms to promote appropriate waits and avoid
    harmful delays for both those who receive and
    those who give care.
  • Efficient by identifying strategies and
    implementing mechanisms to avoid waste, in
    particular waste of equipment, supplies, ideas,
    energy and money.
  • Equitable by identifying strategies and
    implementing mechanisms to provide care that does
    not vary in quality because of personal
    characteristics that are not in the control of
    individuals such as gender, ethnicity, geographic
    location, and socioeconomic status.
  • Each principle is further developed in the HRAP
    through a series of sub-principles.

8
Key Chapter Information
  • Chapter 1 Inpatient, Emergency, and
    Hospital-Based Services
  • Chapter 2 Ambulatory Care Services
  • Chapter 3 Community-Based Services
  • Chapter 4 Other Medical Services
  • Chapter 5 Healthcare Workforce
  • Chapter 6 Healthcare Information Technology
  • Chapter 7 Certificate of Need Standards

9
Chapter 5 Quick Facts Healthcare Workforce
  • Healthcare Workforce Quick Facts
  • Vermont experienced a net increase of 85
    physicians (43 primary care physicians and 42
    specialists) between 2000 and 2002.
  • More than one-fourth of the 1,565 physicians
    licensed to practice medicine in Vermont provide
    less than 30 patient-care hours per week.
  • Maldistributions exist for the supply of both
    nurse practitioner and physician assistant
    midlevel practitioners across the state on both
    FTE and population-based measures.
  • Advance practice registered nurses include nurse
    practitioners, nurse midwives, nurse
    anesthetists. Nurse midwives and psychiatric
    nurse practitioners are in short supply in
    several Vermont HSAs a disproportionate portion
    of FTEs in these disciplines work in the
    Burlington area.
  • Reflecting national nursing shortages, forecasts
    indicate the supply of nursing professionals will
    not meet Vermonters needs after 2011.
    Furthermore, nursing professions experience high
    vacancy and turnover rates, particularly in home-
    and long-term care.
  • Thirteen Vermont counties have been designated
    Medically Underserved Areas by the Federal
    government Addison, Caledonia, Chittenden,
    Essex. Franklin, Grand Isle, Lamoille, Orange,
    Orleans, Rutland, Washington, Windham and Windsor.

10
Workforce Priorities
  • Primary care access, particularly for Medicaid
    population
  • Nursing shortages
  • Aging workforce
  • Faculty shortages
  • Long-term care shortages
  • Advance practice nurse shortages
  • Personal care worker shortages
  • Mental Health
  • psychiatry, especially adolescent
  • mental health/substance abuse
  • Dental workforce, particularly for low income
    populations

11
HRAP Recommendations on Workforce
  • Target maldistribution of workforce, particularly
    primary care
  • Recruitment programs such as loan repayment
  • Career ladder development
  • Job re-design enabling older nurses to remain in
    jobs longer
  • Faculty education initiatives
  • Develop standards for optimum mix of providers,
    particularly in primary care
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