1. Sharon Moffatt RN MSN Acting Commissioner of Health November 6, 2006

2. The Vermont Department of Health The Vermont Blueprint for Health… … gives people with chronic conditions the information, tools and encouragement they need to be successfully to manage their health

3. The Vermont Department of Health Why is change needed? Growing health care costs Vermont health care costs 11.5% from 2001 Vermont Medicaid expenditures 13.4 % since 1997 All insurers expenditures 9.2% since 1997

4. The Vermont Department of Health 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

5. The Vermont Department of Health Vermonters with Chronic Disease

6. The Vermont Department of Health

7. 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

8. The Vermont Department of Health Vermont Obesity Trends 53% of Vermont Adults are obese or overweight OR 226,615 Vermonters are above a healthy weight

9. The Vermont Department of Health Deaths Per Thousand Adults 2.50 2.25 2.00 1.75 1.50 1.25 19801990200020102020203020402050 Time (Year) No Change Obesity Prevention Better Care Reducing diabetes deaths: options

10. The Vermont Department of Health Deaths from complications–per thousand Adults No major changes – status quo Care and reduction in caloric intake 2.50 2.25 2.00 1.75 1.50 1.25 19801990200020102020203020402050 Time (Year) Obesity Prevention and Better Care No Change Reducing diabetes deaths: comprehensive approach

11. The Vermont Department of Health Vermont Blueprint A system of care that enables Vermonters to lead healthier lives A system of care that is financially sustainable inable;and, A public-private partnership that sustains the new system of care

12. The Vermont Department of Health The Chronic Care Model

13. The Vermont Department of Health Social Ecological Model Behavior change influenced at all levels Individual Interpersonal Public Policy Community Organizational

14. The Vermont Department of Health 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

15. The Vermont Department of Health Self Management Healthy Living Workshops

16. The Vermont Department of Health Community

17. The Vermont Department of Health Blueprint Budget 2006 By Focus Area

18. The Vermont Department of Health Blueprint for HealthFY 06 Self Management 6 Master Trainers 45 Instructors 200 participants (200 more by 6/30) 15 towns 5 VDH staff Health Systems Disease Management Report Pay 4 Performance (study started) 1 VDH staff (PT) Information Systems VHR to practices Registry Selected Practice needs Analysis 4 VDH staff Provider Practice Pilots: 19 Practices 45 Providers 1200 patients Others: 20 practices 1VDH staff (PT) Community Services 5 Communities 10 District offices 18 towns-physical activity VT-211 in 2 pilot communities 28 VDH staff participate

19. The Vermont Department of Health Healthy Living Participants Medical Care MD Visits ED Visits Both visits to a doctors office and visits to the ED went down significantly at six and 12 months

20. The Vermont Department of Health Daily Activities For many participants, 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.

21. The Vermont Department of Health Physical Activities And Abilities There is an increase in the number of participants who are able to walk at least 30-60 minutes a week. Many report having no difficulty walking outdoors, dressing themselves, and picking up clothes from the floor

22. The Vermont Department of Health Resources/References The Chronic Care Model: Improving chronic illness care a national program of The Robert Wood Johnson Foundation, www.improvingchroniccare.org 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.

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

24. The Vermont Department of Health Best Practice Guidelines Agency for Healthcare Research and Quality www.guidelines.govwww.guidelines.gov Institute for Clinical Systems Integration www.icsi.orgwww.icsi.org American Diabetes Association www.diabetes.orgwww.diabetes.org American Heart Association www.americanheart.orgwww.americanheart.org

25. The Vermont Department of Health Vermont Blueprint for Health www.healthvermont.gov