This past June, the SCI program convened health officials from five states to Burlington, Vermont to witness Vermont’s health reform efforts in action. The timing was particularly appropriate given the recent focus on elements of Vermont’s Blueprint for Health in the national health care reform debate in Congress. The Blueprint started at one pilot program site in 2003 as a new way of looking at the practice of medicine and chronic care treatment. The program was refocused and expanded with passage of Vermont’s 2006 comprehensive health reform bill, the Health Care Affordability Act. Perhaps one of the most important elements of the Blueprint is the creation of “community care teams” which facilitates the collaboration of nurses, health educators, and social workers to better enable patients to manage their own chronic conditions. Most of the extra services provided by the team are paid for through grants from the Vermont Department of Health, the state’s three major health insurance companies, and Medicaid.
In an Associated Press article on Vermont health reform, SCI’s Director, Enrique Martinez-Vidal, explained that the Blueprint program “is the model for a delivery system redesign that has great potential for cost savings as well as the improvement for the health of the population of this country.” Currently, participating commercial carriers, Medicaid, and the State, who is providing the portion that would apply to Medicare beneficiaries, are paying participating physicians an additional care coordination fee based on the practice meeting certain criteria for being a medical home; in addition, community health teams are being supported, to provide multidisciplinary care assistance to all participating practices. The future vision of the delivery system redesign and payment reform is that eventually providers will be paid for the totality of care and not for every episode of care. While not enough time has lapsed for the data to prove the value of the model, Vermont has started to see a reduction in emergency room visits.
