1. Building the Digital Infrastructure for Vermont’s Learning Health System ONC HIT Policy Committee Testimony September 14, 2011 Hunt Blair, Deputy Commissioner Division of Health Reform Department of Vermont Health Access (Medicaid)

2. 2

3. 3 Building a Paradigm for “Systemness”  We do not distinguish between HIT/HIE and health reform; we have an integrated strategy to support a foundation of Advanced Primary Care and Community Health Teams known as The Vermont Blueprint for Health – and which we’ll next expand to include Accountable Care Partnerships.  The Blueprint’s design principles: All Vermonters should have a Blueprint for Health primary care provider All Blueprint for Health providers are supported by Community Health Teams that have nurses and specialists in nutrition, exercise, counseling and more to support individuals to lead healthier lives. Specialty care is fully integrated with the patient’s Blueprint Providers and Community Health Team. Blueprint Providers and Community Health Teams are able to address the population health needs of their communities.  Fragmentation of care should be a “never event.”

4. 4 “Systemness” Extends to the State Enterprise  Extending that logic: fragmentation of state-sponsored health and human services for adults and children should be a “never event” and HIE is the vehicle to ensure that.  Better together, or the Vermont “Ben & Jerry’s factor” to mix in lots of yummy ingredients in tasty combinations: we haven’t met systems we can’t integrate & improve  SOA framework supports technical integration that helps model programmatic integration  Building a distributed network ultra-large scale system of systems where the State supports and helps to provide the system structure / framework for better integrated health care and human services

5. 5 Higher Acuity & Complexity Lower Acuity & Complexity Locus of Service & Support Level of Need Health Maintenance Prevention Access Communication Self Management Support Guideline Based Care Coordinate Referrals Coordinate Assessments Panel Management Advanced Primary Care Practice Medical Homes Targeted Services for Complex Cases Support Patients & Families Support Practices Coordinate Care Coordinate Services Referrals & Transitions Case Management o Medicaid Care Coordinators o Senior Services Coordinators Self Management Support Counseling Population Management Community Health Teams Augmented by SASH Teams & Medicaid Care Coordinators VT Blueprint Continuum of Care – General Health Services Specialty Care Advanced Assessments Advanced Treatments Advanced Case Management Social Services Economic Services Community Programs Self Management Support Public Health Programs

6. 6 Advanced Primary Care Practice Medical Homes Community Health Teams Including SASH Teams & Medicaid Care Coordinators Blueprint Supported by an HIT “neural network” Specialized & Targeted Services Covisint / DocSite Clinical Repository, VT HIE Network & AHS Enterprise Architecture Connectivity across the continuum

7. 7 Building on Core SOA Enterprise Components

8. 8

9. 9 Organizing Principles & Guidelines Guideline & Standards Implementation Action Strategic Support for Delivery System Reforms Operationalize a Learning Health System IOM Strategy Map, Framework, and Guiding Principles for a Learning Health System & Supportive Electronic Infrastructure Consensus oriented process to review, refine, and update recommendations for a Learning Health System Dissemination of recommendations for implementation and evaluation of Learning Health System operations across the country National Institutes & Agencies National guidelines include key assessments, & recommended treatment options Recommend guideline based core data elements (eg. Process and health status) Recommend metrics aligned directly with core data elements Support for health services & translational research linked to use of recommended data elements, measures, assessments, and treatment options. Participation in Learning Health System activities, shared learning, dissemination of outcomes & best practices, ongoing refinement of guidelines CMS Goals for novel payment and clinical models (quality, cost, patients experience) Recommend core data elements for tracking quality, cost, and patient experience Recommend metrics aligned directly with core data elements Demonstrations with payment strategies that promote tracking, use, and exchange of guideline based data elements & metrics Participation in Learning Health System activities, shared learning, dissemination of effective clinical models and financial reforms ONC Technical standards for data exchange Stage 1 meaningful use promotes use of certified EHRs and specific functions Evaluation of Stage 1 meaningful use Align stages 2 & 3 of meaningful use, and financial incentives, with tracking, utilization, and exchange of guideline based data elements & metrics Participation in Learning Health System activities, shared learning, dissemination of effective health information models, refinement of meaningful use strategies States (regions, systems) Guiding legislation or policy for a Learning Health System & Supportive Electronic Infrastructure Evidence based models & standards for implementing delivery system reforms and a supportive electronic infrastructure Dedicated leadership & resources for implementation of Delivery System Reforms & Electronic Infrastructure Implementation and ongoing refinement of guideline based health services and a supportive digital infrastructure …. Learning Health Systems