Vermont Blueprint for Health
Program Location:
Montpelier, VT
Payer Type:
Multi-Payer
Parent Program:
Payers:
Medicaid
Medicare
BlueCross
MVP
Cigna
Accreditation/Recognition:
NCQA
Reported Outcomes
Description:
The Blueprint for Health (Blueprint) is Vermont’s state-led initiative charged with implementing sustainable health care delivery reform. Blueprint was originally codified in Vermont statute in 2006, then modified further in 2007, 2008, and finally in 2010 with Vermont Act 128 amending 18 V.S.A. Chapter 13. The law defines Blueprint as a “program for integrating a system of health care for patients, improving the health of the overall population, and improving control over health care costs by promoting health maintenance, prevention, and care coordination and management.”
To that end, the Blueprint has worked with stakeholders in each of Vermont’s Health Service Areas to implement several PCMH related initatives including:
- Advanced primary care practices that are recognized as patient centered medical homes (PCMHs) by the National Committee for Quality Assurance (NCQA)
- Multi-disciplinary core Community Health Teams (CHT) and additional specialized carecoordinators, which support PCMHs and provide the general and target population access to multi-disciplinary health services
- Multi-insurer payment reforms that fund PCMH transformation and community health teams
- Implementation of health information technology (HIT) to support health information exchange, guideline-based care, population management, and comparative evaluation
- Multi-faceted evaluation system to determine the impacts of health care reform initiatives
- A Learning Health System that helps practices and community health teams plan and implement PCMH operations, and supports ongoing quality improvement and innovation
In 2010, Vermont was selected to participate in the Centers for Medicare & Medicaid Services’ Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration Project. Through the demonstration, Medicare became a participating insurer with the Blueprint– joining private insurers and Medicaid – to provide financial support for the advanced primary care practices.
Related News & Resources
Payment Model:
Leaving the current fee-for-service payments to providers untouched, the Blueprint adds two key payment reforms:
1. A per Member per Month (PMPM) payment made by all payers to primary care providers with a qualifying score on the NCQA Patient-Centered Medical Home standards. The PMPM amount depends on the actual score on the standards with higher scores resulting in higher payments, so this payment reform incents improvements in quality of care.
2. Capacity payments to support the salaries and expenses of the community health teams. The payment is scaled at $350,000 for every 20,000 patients. Vermont’s commercial and public payers all share equally in the cost to support the CHTs. The Medicaid portion of this capacity payment is made monthly to a lead administrative agent in each of 14 health service areas. The payment is based on a quarterly calculation of attributed patients to the participating primary care practices.
Fewer ED / Hospital Visits:
Population Health Management (September 2015)
- Reduction in inpatient discharges reduced by 8.8 per 1000 members (p<.001)
- Reduction in inpatient days reduced by 49.6 per 1000 members (p<.001)
- Significant reduction in standard imaging, advanced imaging, echography
Population Health Management (July 2014)
-
inpatient days per 1000 members decreased by nearly 8%
Blueprint for Health Annual Report (January 2014)
- fewer hospitalizations for commercially insured adults (47.1 vs. 53.4 in control group)
- fewer hospitalizations for Medicaid insured children (23.9 vs 33.3 in control group)
- fewer hospitalizations for Medicaid insured adults (137.8 vs. 149.4 in control group)
- fewer ED visits for commercially insured adults (205.1 vs 214.7 in control group)
- fewer ED visits for Medicaid insured children (521 vs 485.1 in control group)
Improved Access:
Blueprint for Health Annual Report (January 2014)
- Increase in primary care visits for commercially insured children and Medicaid adults
Cost Savings:
Population Health Management (September 2015)
- Participant expenditures were reduced by -$482 PMPY* (p<.001)
- Reduction in inpatient (-$218 PMPY*; p<.001) and outpatient hospital expenditures (-$154 PMPY*; p<.001)
- Increase in expenditures for dental, social, and community-based support services ($57 PMPY*; p<.001)
- Total annual reduction in expenditures was $104.4 million
- Medical expenditures decreased by approximately $5.8 million for every $1 million spent on the Blueprint initiative
Blueprint for Health Annual report (January 2015)
- In 2013, lower healthcare expenditures for Blueprint participants offset the payments that insurers made for medical homes and community health teams
- In 2013, when comparing Blueprint participants to non-pcmh primary care practices, the total expenditures per capita were:
- $101 less per Blueprint participant for Medicaid
- $565 less per Blueprint participant for commercial payers
Blueprint for Health Annual Report (January 2014)
Total annual expenditures in 2012 were reduced by:
- $386 (19%) for each commercially insured participant in the 1-17 age group
- $586 (11%) for each commercially insured participant in the 18-64 age group
- $200 for each Mediaid insured participant in the 1-17 age group
- $447 for each Medicaid insured participant in the 18-64 age group
Increased Preventive Services:
Blueprint for Health Annual Report (January 2014)
Increased preventive services:
- increase in breast cancer screening in commercially insured adults (78.5 vs 77.1 in control group)
- increase in cervicial cancer screenings in commercially insured adults (68.8 vs 67 in control group)
- increase in cervical cancer screenings in Medicaid insured adults (59.6 vs 55.3 in control group)
- increase in adolescent well-care visits in commercially insured participants ( 59.8 vs 53.2 in control group)
Last updated February 2016
