1. January 12-13, 2006 Montpelier, VT Chronic Care Management for all Vermonters Kenneth E. Thorpe, Ph.D. Robert W. Woodruff Professor and Chair Department of Health Policy and Management Rollins School of Public Health Emory University kthorpe@sph.emory.edu

2. January 12-13, 2006 Montpelier, VT Key Facts Cost of treating chronically ill patients accounts for 75% of health spending in Vermont (over $3 Billion per year) Rise in chronic illnesses and obesity key factors in driving growth in spending Chronically ill patients receive about 50% of the clinically recommended care The IOM and others have highlighted the need to dramatically restructure how we deliver services –Patient focused/central –integrated multi-disciplinary approach –Proactive not reactive model

3. January 12-13, 2006 Montpelier, VT Disease States Commonly Targeted by DM Industry Heart Failure, Cardiovascular disease Asthma Chronic Obstructive Pulmonary Disease (COPD) Diabetes Cancer Maternal/Neonatal ESRD Cancer Depression, other mental disorders

4. January 12-13, 2006 Montpelier, VT Components of DM Programs Population Screening Using claims/clinical data to identify patients for disease management Patient Risk Management Surveying patients about disease status/burden to identify for disease management Team-Based Care Using formalized teams to increase collaboration of care Alternative Encounters Providing opportunities outside of the face-to- face encounter for relationship Cross-Consortium Coordination Managing across sites and settings to improve care continuity Patient Education Teaching patients about their disease Outreach/Case Management Tracking patients and their status proactively Decision Support At the Point of Care Translating disease management guidelines to patients-specific recommendations for clinicians. Guidelines/Protocol Providing information to clinicians on recommended clinical management Performance Feedback Measuring performance in delivering desired care and achieving improved outcomes

5. January 12-13, 2006 Montpelier, VT Chronic Care Plan Infrastructure for providing integrated chronic care (registry) currently under development in parts of the state Infrastructure would be used by private health plans, Medicaid (and the uninsured) and others to manage chronically ill patients Uniform set of clinical performance measures would be reported by all plans (e.g. % of diabetics receiving 4 or more Hgb A1c tests per year).

6. January 12-13, 2006 Montpelier, VT Chronic Care Chronically ill patients would be enrolled in a chronic care plan State would create set of clinical performance measures for each chronic condition. No co-pays would be charged for these clinically recommended services Medicaid would follow the lead of other states and through an RFP process select a vendor to manage their chronically ill patients Uninsured patients would be enrolled in the state chronic care program administered by Medicaid.

7. January 12-13, 2006 Montpelier, VT Green Mountain Health Uninsured Vermonters would receive a defined benefit package of primary and preventive health care. These services would be based on the US Preventive Services Task Force Based on the HRA, uninsured would be enrolled in same chronic care plan as Medicaid chronically ill Medicaid through the RFP process would expect savings from the selected vendor of 5-10% per member (based on other states experiences)

8. January 12-13, 2006 Montpelier, VT Green Mountain Health (GMH) Upon receipt of GMH card, the uninsured would receive a health risk appraisal to identify at-risk individuals The HRA would identify medical conditions requiring further evaluation/treatment and referral to a physician as indicated Treatment plan would include clinical and lifestyle action plan Progress in meeting these clinical goals reported annually.

9. January 12-13, 2006 Montpelier, VT Green Mountain Health Uninsured that are not chronically ill would receive all primary and preventive services. Hospitalizations unrelated to chronic episodes would not be covered by Green Mountain Health and could be covered through each hospitals written charity care policypossibly with patient contributions based on income and/or additional state support or requirements.

10. January 12-13, 2006 Montpelier, VT Conclusion Integrating the Chronic Care Initiative with Green Mountain Health presents opportunities to: –Improve the coordination and quality of care –Provide coverage for the un/under-insured –Bend the cost curve.