Vermont Blueprint for Health Sharon Moffatt Commissioner of Health August 2007

Sickest 10 % Account for 64 % of Health Care Expenses 1% 5% 10% 49% 64% 24% 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 (1):249–57. 50% 97% $36,280 $12,046 $6,992 $715 Expenditure threshold (2003 dollars)

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

Vermonters with Chronic Disease

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

Chronic Disease and Obesity

Deaths Per Thousand Adults Time (Year) No Change Obesity Prevention Better Care Reducing diabetes deaths: options

Deaths from complications–per thousand Adults No major changes – status quo Care and reduction in caloric intake Time (Year) Obesity Prevention and Better Care No Change Reducing diabetes deaths: comprehensive approach

The Model for Chronic Disease Care

Vermont Blueprint Model for Health Healthy Vermonters Patients and Families Community Health Provider Team Practice standards Office Systems Support Information Systems Built Environment Health Services Health Awareness Healthy Options Information Systems Health Systems Public Policy Public Health System policy Quality care Reimbursement Financing Continuity Coordination Information Systems Policies Infrastructure Financing Resources Advocacy Regulation Information Systems Health knowledge Self-manage- ment skills Supportive home environment Information Systems Blueprint Partnership

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

Public Policy Legislation 2006 and 2007  Full support of Governor Douglas’s 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

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

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

Healthy Living Participants Medical Care MD Visits ED Visits Visits to a health care provider’s office and the Emergency Dept decreased significantly at 6 & 12 months

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.

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

Blueprint Budget 2006 By Focus Area

Best Practice Guidelines  Agency for Healthcare Research and Quality  Institute for Clinical Systems Integration  American Diabetes Association  American Heart Association

Resources/References  The Chronic Care Model: Improving chronic illness care a national program of The Robert Wood Johnson Foundation,  Wagner, E.H. Chronic Disease Management: What will it take to improve care for chronic illness? Effective Clinical Practice 1998; 12-4.

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

Resources/References  The Model for Improvement by the Institute for Health Improvement  The Quality of Health Care Delivered to Adults in the United States. New England Journal of Medicine 2003, 348:26.  Vermont Department of Health website: