Monday, January 17, 2011

Vermont's Blueprint for Health

Craig Jones, M.D., Executive Director for the Vermont Blueprint for Health program speaking at the December Health Affairs Innovation Conference reported that approximately 50 percent of Vermont’s population is overweight and roughly 20 percent are obese which eventually contributes greatly to developing chronic diseases.

To address the health needs in the state, the Blueprint program provides information, tools, and support to help manage an individual’s health and well being plus the program assists primary care clinicians to provide coordinated and patient-centered care. Basically, Blueprint provides a foundation for medical homes that includes community health teams supporting coordinated care linking to a broad range of services.

The program operates with local multidisciplinary teams set up to provide care coordination for individual patients. The teams consist of nurse coordinators, medical social workers, behavioral specialists, dieticians, public health prevention specialists, and other health professionals.

The Vermont Blueprint program initially selected six communities to participate and the program started by targeting diabetes care. This was accomplished by training providers, providing for payment incentives, using health IT, providing community outreach, and evidence-based care. Today, communities all over the state are joining the program.

Developing a workable payment system is a major issue in Vermont and the state also needs to address the state’s financial issues. The Blueprint program part of the answer expects to save $100 million over expected normal growth by 2013. The program has tested and supports multi-insurer payment reform to help medical homes and community health teams. Medicaid and private payers participate and providers are reimbursed based on their NCQA-PCMH score.

In addition, their health information infrastructure includes a web-based clinical tracking system called (DocSite), to provide electronic prescribing, EMRs, and a health information exchange network. The data is transmitted between EMRs, hospital data sources, and DocSite. Also available is an evaluation infrastructure that routinely collects data to support services and guide quality improvements.

During the pilot program for Blueprint, Medicare was paid by the state out of general fund dollars. This could not continue, so as a result, Vermont was selected to take part in the Medicare demonstration project along with other states.

Legislation had been introduced in the state to expand Blueprint and the legislation has a requirement for the Department of Vermont Health Access to expand Blueprint to at least two primary care practices in each hospital service area by July 2011 and to all primary care practices who wish to participate by October 1, 2013. The ability to expand further was dependent on receiving the CMS demonstration project grant.

The Commonwealth Fund and the National Academy for State Health Policy recently published a new report “Leading the Way: State Innovations in Primary and Chronic Care Delivery.” The report studies efforts underway in six states including Vermont. The report examines the roles that the states are playing to reorganize the delivery of primary and chronic care in more efficient and effective ways.

For more information on the Health Affairs Innovation Conference, go to, and to view the new Commonwealth Fund and NASHP report, go to