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March2017 1
In2013,Vermontwasawardeda$45millionStateInnovationModels(SIM)grantfromthefederalCentersforMedicareandMedicaidInnovation(CMMI).Theresultingeffort,knownastheVermontHealthCareInnovationProject(VHCIP),hasworkedtotestinnovativepaymentanddeliverysystemreformmodelsthroughoutourstate.
Vermont’spaymentanddeliverysystemreformsaredesignedtohelpVermontachievetheTripleAimofbettercare,betterhealth,andlowercosts.Inordertoachievethis,weareworkingtodesignvalue-basedpaymentmodelsforallpayers,supportproviderreadinessforincreasedaccountability,andimproveourhealthdatainfrastructuretoenabletimelyinformationforclinicaldecision-makingandpolicy-making.Collaborationbetweenthepublicandprivatesectorsisahallmarkofouractivities;wearecreatingcommitmenttochangeandsynergybetweenpublicandprivatecultures,policies,andbehaviors.
VHCIP’sworkspansinfivefocusareas:PaymentModelDesignandImplementation,PracticeTransformation,HealthDataInfrastructure,Evaluation,andProjectManagement.
PaymentModelDesignandImplementation:Supportingcreationandimplementationofvalue-basedpaymentsforprovidersinVermontacrossallpayers.
VHCIP’spaymentmodeldesignactivitieshavebeenperformedonamulti-payerbasisasmuchaspossible.Paymentmodeldesignandimplementationactivitieshaveincluded:
• MedicaidandCommercialSharedSavingsACOPrograms• Pay-for-Performance• ProspectivePaymentSystems• Capitation
Thesepaymentmodelshavebeendesignedtomeetproviderswheretheyare,whethertheyarereadytoassumefinancialriskorneedadditionalreadinesssupports.TheyarealsodesignedtoensurethatthepayerscanoperationalizethenewstructuresandtheStatecanevaluateeachprogram.Byestablishingapathforallproviders,wearephasinginreformsbroadly,butresponsibly.
Buildingoffofthesuccessfullaunchofourpatient-centeredmedicalhomeefforts(theBlueprintforHealthprogram),VermontlaunchedMedicaidandcommercialSharedSavingsACOProgramsin2014.Nearly60%ofVermonterswereparticipantsinthesetwoprograms,whichalignedwiththeMedicareSharedSavingsACOProgram.ThethreeACOsthatparticipatedintheseprogramsincludedthemajorityofVermont’shealthcareproviders—includingmanyofourlong-termservicesandsupportsandmentalhealthproviders.ThecommercialSharedSavingsACOProgramcontinuesin2017.
InOctober2016,VermontreachedagreementwithCMSonanAll-PayerModel.TheVermontAll-PayerACOModelisanagreementbetweenthestateandthefederalgovernmentonasustainablerateofgrowthforhealthcarespendinginthatstate;itincludesstrictqualityandperformancemeasurementandisintentionallyalignedwithVermont’sGlobalCommitmentforHealth1115waiverrenewal.ItbuildsonthereformsandinfrastructuredevelopedandpilotedunderVHCIPandwillbethenextbigstepforwardinVermont’shealthsystemtransformation.AcontractbetweentheStateandOneCareVermonttolauncharisk-bearingMedicaidACOunderaVermontMedicaidNextGenerationprogram,
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signedinFebruary2017forapilotperformanceperiodofcalendaryear2017,isthefirststepofAll-PayerModelImplementation.
PracticeTransformation:Enablingproviderreadinessandencouragingpracticetransformation.
VHCIP’scaredeliverytransformationactivitiesaredesignedtoenableproviderreadinesstoparticipateinalternativepaymentmodelsandaccepthigherlevelsoffinancialriskandaccountability.ThisareaofworkincludesmonitoringVermont’sexistingworkforce,aswellasdesigningtransformationactivitiesthatsupportproviderreadiness.TwoareasofsignificantsuccesswithinthisworkstreamincludetheIntegratedCommunitiesCareManagementLearningCollaborativeandourSub-GrantProgram.
TheIntegratedCommunitiesCareManagementLearningCollaborative,launchedinlate2014,soughttoimprovecareandreducefragmentationforat-riskVermontersandtheirfamiliesbyenhancingintegratedcaremanagementacrossmulti-organizationalteamsofhealthandhumanservicesproviders.ThefirstcohortoftheLearningCollaborativeincludedthreecommunitiesand90providers,andtheinitiativeexpandedtoaddtwonewcohortswithteamsofhealthcareandserviceprovidersfrom8additionalinterestedcommunitiesinthestate.TheLearningCollaborativeutilizedaPlan-Do-Study-Actqualityimprovementmodelpunctuatedwithperiodicin-personandvirtuallearningsessions.Theprogramisevaluatingwhethertheseinterventionsimprovecoordinationofcareandservices.
Inaddition,VHCIPinvestednearly$5millionover3yearsinaSub-GrantProgramtosupportprovider-levelinnovation.TheSub-GrantProgramsupportedover15,000Vermontprovidersintransformingcaredeliverymodelsandimpactedover300,000Vermontersfromalloverthestate.Theprogramactedasatestinggroundforprovider-ledchange,withmostprojectsdrivenbyproviderpracticesandcollaborations.
HealthDataInfrastructure:Supportingprovider,payer,andStatereadinesstoparticipateinalternativepaymentmodels.
VHCIP’shealthdatainfrastructuredevelopmentactivitieshavesupportedthedevelopmentofclinical,claims,andsurveydatasystemsneededtosupportimplementationofalternativepaymentmodels.VHCIPismakingstrategicinvestmentsinclinicaldatasystemstoallowforpassivequalitymeasurement–reducingproviderburdenwhileensuringaccountabilityforhealthcarequality–andtosupportreal-timedecision-makingforclinicians.VHCIPisalsoworkingtostrengthenVermont’sdatainfrastructuretosupportinteroperabilityofclaimsandclinicaldataandpredictiveanalytics.
Theseinvestmentshaveyieldedsignificantimprovementsinthequalityandquantityofdataflowingfromproviders’electronicmedicalrecordsintotheVermontHealthInformationExchange(VHIE).Wehavealsoidentifieddatagapsfornon-meaningfuluseproviderstosupportstrategicplanningarounddatauseforallprovidersacrossthecontinuum.
Evaluation:Ongoingevaluationofinvestmentsandpolicydecisions.
AllVHCIPeffortsareevaluatedtoensuretheyaresupportingpositiveoutcomesforVermont,includingitsresidents,payers,andproviders.Evaluationsoccurbyprogram,bypopulation,andbyregiontoensurethatwearenotinadvertentlycausingunintendedconsequences,andtosupportdisseminationoflessonslearnedquicklyandexpanduseofbestpractices.
ProjectManagement:SupportforallVHCIPactivities.
VHCIPactivitiesaresupportedbystaffandcontractorswhoensuretheprojectisorganized,sufficientlyresourced,andisabletomeetallgoalsandmilestones.
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VHCIPProjectStatusReportsMarch2017
FocusArea:MilestonesSupportingCMMIRequirements.............................................................................................4
Project:PopulationHealthPlan.........................................................................................................................................4Project:SustainabilityPlan.................................................................................................................................................5
FocusArea:PaymentModelDesignandImplementation.............................................................................................6Project:ACOSharedSavingsPrograms(SSPs)...................................................................................................................6Project:EpisodesofCare(EOCs)(ProjectComplete).........................................................................................................8Project:Pay-for-Performance(BlueprintforHealth).........................................................................................................9Project:HealthHome(Hub&Spoke)...............................................................................................................................11Project:AccountableCommunitiesforHealth.................................................................................................................12Project:ProspectivePaymentSystem–HomeHealth(ProjectComplete).....................................................................14Project:All-PayerModel..................................................................................................................................................15Project:MedicaidValue-BasedPurchasing(MedicaidPathway–MentalHealth/SubstanceUse).................................18Project:MedicaidValue-BasedPurchasing(MedicaidPathway–LTSS/ChoicesforCare)..............................................19Project:StateActivitiestoSupportModelDesignandImplementation–Medicaid.......................................................20
FocusArea:PracticeTransformation..........................................................................................................................22
Project:LearningCollaboratives(ProjectComplete).......................................................................................................22Project:CoreCompetencyTrainings(ProjectComplete).................................................................................................24Project:Sub-GrantProgram–Sub-Grants.......................................................................................................................26Project:Sub-GrantProgram–TechnicalAssistance........................................................................................................28Project:RegionalCollaborations......................................................................................................................................29Project:Workforce–CareManagementInventory(ProjectComplete)..........................................................................31Project:Workforce–DemandDataCollectionandAnalysis...........................................................................................32Project:Workforce–SupplyDataCollectionandAnalysis..............................................................................................33
FocusArea:HealthDataInfrastructure.......................................................................................................................35
Project:ExpandConnectivitytoHIE–GapAnalyses(ProjectComplete)........................................................................35Project:ExpandConnectivitytoHIE–GapRemediation.................................................................................................36Project:ExpandConnectivitytoHIE–DataExtractsfromHIE(ProjectComplete).........................................................38Project:ImproveQualityofDataFlowingintoHIE(ProjectComplete)...........................................................................39Project:Telehealth–StrategicPlan(ProjectComplete)..................................................................................................41Project:Telehealth–Implementation.............................................................................................................................42Project:EMRExpansion(ProjectComplete)....................................................................................................................44Project:DataWarehousing..............................................................................................................................................45Project:CareManagementTools–SharedCarePlanProject(ProjectComplete)..........................................................47Project:CareManagementTools–UniversalTransferProtocol(ProjectComplete)......................................................49Project:CareManagementTools–EventNotificationSystem........................................................................................51Project:GeneralHealthData–DataInventory(ProjectComplete)................................................................................52Project:GeneralHealthData–HIEPlanning(ProjectComplete)....................................................................................53Project:GeneralHealthData–ExpertSupport(ProjectComplete)................................................................................54
FocusArea:Evaluation...............................................................................................................................................55Projects:Self-EvaluationPlanandExecution;Surveys;MonitoringandEvaluationActivitieswithinPaymentPrograms..........................................................................................................................................................................................55
March2017 4
FocusArea:MilestonesSupportingCMMIRequirements
FocusArea:MilestonesSupportingCMMIRequirementsProject:PopulationHealthPlan
ProjectSummary:ThePopulationHealthPlanproposesastrategicpathwayforwardtosystematicallyconnectintegratedcaremanagementeffortswithcommunity-widepreventionstrategiestoimprovepopulationhealthoutcomes,buildingonVermont’sexistingStateHealthImprovementPlan.TheplanbuildsontheworkofthePopulationHealthWorkGroup.Itoutlinesprinciplesforintegratingpopulationhealthandpreventionintobroaderhealthreformeffortsandidentifiespolicyoptionstosupportpopulationhealthintegration.ThePopulationHealthPlanisarequireddeliverableofVermont’sSIMgrant.WorktodevelopthePopulationHealthPlanisongoing;itwillbecompletedbytheendofPerformancePeriod3.ProjectTimelineandKeyFacts:• 2014–Developeddefinitionofpopulationhealthandcametoconsensusoncoreconcepts.• 2015–DevelopedPopulationHealthPlanoutlinewithsupportfromSIMTA(CDC/CHCS)andcontractors.• January-June2016–FinalizedPopulationHealthPlanoutlinewithPopulationHealthWorkGroupinput;
collectedandorganizedmaterialsonpopulationhealthmeasures,paymentmodels,caremodels,andfinancingmechanisms.InJune2016,acontractorwasengagedtosupportPopulationHealthPlanwriting.
• July-November2016–DraftPopulationHealthPlandeveloped.AdraftofthePopulationHealthPlanwasreleasedtoallVHCIPstakeholdersforpubliccommentonSeptember27andpresentedtoeachVHCIPworkgroupinOctober.AreviseddraftwaspresentedtotheCoreTeaminNovember.
• December2016-June2017–FinalizePopulationHealthPlan:CoreTeamapproval,andsubmissiontoCMMI.StatusUpdate/ProgressTowardMilestonesandGoals:• During2014and2015,thePopulationHealthWorkGroupandstaffdevelopedadefinitionofpopulationhealth,
cametoconsensusoncoreconcepts,anddevelopedkeydocumentstocommunicatecoreconcepts.• In2015,projectstaffdevelopedaroughoutlineforthePopulationHealthPlanwithtechnicalassistancesupport
fromCDCandCHCS.Thisoutlinewasrefinedinthefirsthalfof2016withinputfromthePopulationHealthWorkGroupandotherVHCIPworkgroups.
• Inlate2015,DVHAreleasedanRFPseekingsupportforwritingthePopulationHealthPlan;acontractwasexecutedinJune2016withastartdateofJuly1,2016.
• ProjectstaffandcontractorsworkedduringJuly-September2016todraftthePopulationHealthPlan.AdraftwasdistributedtoallVHCIPstakeholdersonSeptember27,andwasreviewedbyVHCIPworkgroupsandtheSteeringCommitteeinOctober2016.AreviseddraftwasdiscussedbytheCoreTeaminNovember.TheCoreTeamvotedtoendorsethedraftPopulationHealthPlan;vettingandeditingwillcontinuethroughSpring2017.
Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:N/APerformancePeriod2:FinalizePopulationHealthPlanoutlineby6/30/16.PerformancePeriod3:FinalizePopulationHealthPlanby6/30/17.Metrics:Thereisnoquarterlyreportingassociatedwiththisproject.AdditionalGoals: #LivesImpacted:N/A #ParticipatingProviders:N/AKeyDocuments:• PopulationHealthWorkGroupEssentialResources• PopulationHealthIntegrationintheVermontHealthCareInnovationProject• ACOs,TACOsandAccountableCommunitiesforHealth• DraftPopulationHealthPlan(RevisedbasedonPublicComment–November2016)
StateofVermontLead(s):GeorgiaMaheras,HeidiKleinContractorsSupporting:JamesHester;VermontPublicHealthAssociation.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Noneatthistime.
March2017 5
FocusArea:MilestonesSupportingCMMIRequirementsProject:SustainabilityPlan
ProjectSummary:TheSustainabilityPlanisarequireddeliverableofVermont’sSIMgrant,andbuildsonongoingconversationsbetweenStateleadership,projectstakeholders,andCMMI.Vermont’shigh-levelsustainabilitystrategyistosustainanycontractsupportandpersonnelusingmodelsavingsandthroughre-deploymentofvacantpositionsandchangesincontractorscopethatmaybenolongerneededgivennewmodelsofprovideroversightandfinancing.DuringPerformancePeriod3,VermontisundertakingadditionaldetailedplanningwithStateandprivatesectorpartnersaroundactivitiesthatwillbesupportedaftertheendofourSIMtestingperiod.ThePlanwillbecompletedbytheendofPerformancePeriod3.ProjectTimelineandKeyFacts:• 2015–Basicsustainabilitystrategydeveloped.• January-June2016–FinalizedSustainabilityPlanstrategyandengagedcontractortosupportSustainabilityPlan
development.• July-October2016–DraftSustainabilityPlandevelopment.• September-December2016–SustainabilityPlanningSub-GroupconvenedtoinformdraftSustainabilityPlan.• November-December2016–PresentdraftSustainabilityPlantoVHCIPworkgroupsforfeedback.• December2016-June2017–FinalizeSustainabilityPlan:CoreTeamapproval,andsubmissiontoCMMI.
StatusUpdate/ProgressTowardMilestonesandGoals:• During2015,projectleadershipdevelopedahigh-levelsustainabilitystrategyandbeganproject-level
sustainabilityplanning.• InMarch2016,VermontreleasedanRFPseekingcontractorsupportforsustainabilityplanninganddevelopment
oftheSustainabilityPlandocument.AcontractorwasselectedandacontractexecutedinJune2016;thecontractorbeganworkinJuly.
• VermontconvenedtheVHCIPSustainabilityPlanningSub-Group,aworkinggroupofprivatesectorstakeholders,inAugust2016.Feedbackfromthisgroupandagroupofhigh-levelStateleadershipinformsthedraftPlan.
• ProjectstaffandcontractorsworkedduringSeptember-October2016todrafttheSustainabilityPlan.AdraftwasdistributedtoallVHCIPstakeholdersinearlyNovember,andwasreviewedanddiscussedbyVHCIPworkgroupsandtheSteeringCommitteeinNovemberandDecember2016.ThedraftSustainabilityPlanandstakeholdercommentstodatewerediscussedbytheCoreTeaminDecember.
• ProjectstaffandcontractorswillworkwiththeCoreTeamtocontinuetoupdateandrevisetheSustainabilityPlaninJanuary-June2017,includingaddingmoredetailedfinancialinformationaboutthecostofsustainingeachworkstreamtotheSustainabilityPlan.ThefinalizedSustainabilityPlanwillbesubmittedtoCMMIinJune2017,followingapprovalbytheCoreTeam.
Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:N/APerformancePeriod2:FinalizeSustainabilityPlanoutlineandprocurecontractortosupportPlandevelopmentby6/30/16.PerformancePeriod3:FinalizeSustainabilityPlanby6/30/17.Metrics:Thereisnoquarterlyreportingassociatedwiththisproject.AdditionalGoals: #LivesImpacted:N/A #ParticipatingProviders:N/AKeyDocuments:StateofVermontLead(s):GeorgiaMaherasContractorsSupporting:MyersandStauffer.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Noneatthistime.
March2017 6
FocusArea:PaymentModelDesignandImplementation
FocusArea:PaymentModelDesignandImplementationProject:ACOSharedSavingsPrograms(SSPs)
ProjectSummary:ModeledcloselyaftertheMedicareSharedSavingsProgram,thisalternativepaymentmodelforcommercialandMedicaidbeneficiariesinVermontwaslaunchedin2014asathree-yearprogram.Beneficiariesareattributedtooneofthreeaccountablecareorganizations(ACOs)intheState.ACOsmustmeetqualitytargetstobeeligibletoshareinanysavings.TheMedicaidSSPendedafterthe2016performanceyear(Year3)andtransitionedintotheVermontMedicaidNextGeneration(VMCN)ACOPrograminfourcommunitiesforthe2017VermontMedicaidNextGeneration(VMNG)pilotyear(seeAll-PayerModelstatusreport).ThecommercialSSPcontinueswithafourthperformanceyearin2017;participantandprovidernumbersforthecommercialSSPwillbeupdatedquarterlyin2017.ProjectTimelineandKeyFacts:• January2014–MedicaidandcommercialSSPslaunched.• July2014–ACOsandDVHAstartedsharingattributionfilesandclaimsdata.• August2014–ACOsandDVHAbeganmeetingmonthlytocollaboratearoundclinical/qualityimprovement.• March2015–Performancemeasures,qualitybenchmarks,andGateandLaddermethodologyreviewedand
modifiedforYear2.• August2015–DVHAelectednottoincludeadditionalcategoriesofserviceinTCOCforYear3.• September2015–Sharedsavings/qualityperformancecalculationsandresultsmadeavailableforPerformance
Year1ofprogram.• October2015–ResultsoftheSSPYear1werepresentedtotheGMCBandVHCIPstakeholders.• December2015-January2016–VHCIPstaffpreparedforYear3MedicaidSSPSPAnegotiations.• March2016–Year3MedicaidSSPSPAsubmittedtoCMS.• June2016–Year3MedicaidSSPSPAapprovedbyCMS.• July-September2016–DVHAandGMCBstaffworkedwithanalyticscontractortopreparequalityandfinancial
performancedataforYear2.PreliminaryresultssenttoACOs/payersfordatavalidationinSeptember.• October2016–Sharedsavings/qualityperformancecalculationsandresultsmadeavailableforPerformance
Year2ofprogram.ResultsofSSPYear2resultswerepresentedtoVHCIPstakeholdersatworkgroupmeetingsandwebinars.
• 2017–PilotyearofVermontMedicaidNextGenerationACOPilotProgram;Year4ofCommercialSSP.StatusUpdate/ProgressTowardMilestonesandGoals:• ExpansionofTotalCostofCareforYear3oftheMedicaidSSPwasconsideredin2015.DVHAreviewedall
potentialservicestoincludeinYear3beforedeterminingnottoincludethem.DVHAnotifiedtheACOsthatitwouldnotincludeadditionalservicesonSeptember1,2015.
• InPerformancePeriod2,theprojectfocusedoncontinuedprogramimplementationandevolutionofprogramstandardsbasedoncostandqualityresultsfromthefirstperformanceperiodofboththeMedicaidandcommercialSSPs.
• DuringPerformancePeriod3,theSSPstargetedadditionalbeneficiariesandfocusedonexpandingthenumberofVermontersservedinthisalternativepaymentmodel.
• ThecommercialSSPdidnotofferdownsideriskasoriginallyproposedinYear3.• TheVermontMedicaidSSPconcludedfollowingtheendofYear3,andDVHAlaunchedarisk-basedVermont
NextGenerationACOPilotPrograminfourcommunitiesforCY2017;thecommercialSSPcontinueswithafourthperformanceyearinCY2017.
Milestones:PerformancePeriod1:
1.ImplementMedicaidandCommercialACOSSPsby1/1/14.2.DevelopACOmodelstandards:ApprovedACOmodelstandards.3.Producequarterlyandyear-endreportsforACOprogramparticipantsandpayers:Evaluationplandeveloped.4.ExecuteMedicaidACOcontracts:NumberACOcontractsexecuted(goal=2).5.ExecutecommercialACOcontracts:NumberofcommercialACOcontractsexecuted(goal=2).
PerformancePeriod1Carryover:Continueimplementationactivitiesinsupportofthe2014SSPperformanceyear.
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1.ContinueimplementationactivitiesinsupportoftheinitialSSPperformanceperiodaccordingtotheSSPprojectplan.2.Modifyprogramstandardsby6/30/15inpreparationforsubsequentperformanceperiods.Finalizecontractamendmentsforsubsequentperformanceperiods.3.CompletefinalcostandqualitycalculationsforinitialSSPperformanceperiodby9/15/15.4.Maintain2contractswithACOsYear1MedicaidACO-SSP.5.Maintain3contractswithACOsYear1commercialACO-SSP.6.Modifyinitialqualitymeasures,targets,andbenchmarksforY2programperiodsby6/30/15(basedonstakeholderinputandnationalmeasureguidelines).7.Medicaid/commercialprogramproviderparticipationtarget:700Medicaid/commercialprogrambeneficiaryattributiontarget:110,000
PerformancePeriod2:ExpandthenumberofpeopleintheSharedSavingsProgramsinPerformancePeriod2by6/30/16:
Medicaid/commercialprogramproviderparticipationtarget:950.Medicaid/commercialprogrambeneficiaryattributiontarget:130,000.
PerformancePeriod3:ProgramsinPerformancePeriod3by12/31/16: Medicaid/commercialprogramproviderparticipationtarget:960.(BaselineasofDecember2015:940)
Medicaid/commercialprogrambeneficiaryattributiontarget:140,000.(BaselineasofDecember2015:179,076)Metrics:CORE_Beneficiariesimpacted_[VT]_VTEmployeesCORE_Beneficiariesimpacted_[VT]_[ACO]_CommercialCORE_Beneficiariesimpacted_[VT]_[ACO]_MedicaidCORE_Beneficiariesimpacted_[VT]_[ACO]_MedicareCORE_ParticipatingProvider_[VT]_[ACO]_CommercialCORE_ParticipatingProvider_[VT]_[ACO]_MedicaidCORE_ParticipatingProvider_[VT]_[ACO]_MedicareCORE_ProviderOrganizations_[VT]_[ACO]_CommercialCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicareCORE_PayerParticipation_[VT]CORE_BMI_[VT]CORE_DiabetesCare_[VT]CORE_EDVisits_[VT]CORE_Readmissions_[VT]CORE_TobaccoScreeningandCessation_[VT]CAHPSClinical&GroupSurveys AdditionalGoals: #LivesImpacted:167,474(asofDecember2016) #ParticipatingProviders:1,007(asofDecember2016)KeyDocuments:• SharedSavingsProgramwebpage• VermontMedicaidSharedSavingsProgram:AnalysesofUtilizationandExpenditureinthe2014Performance
Year• Webinar:Vermont'sYear2MedicaidandCommercialACOSharedSavingsProgramResults
StateofVermontLead(s):AmyCoonradt,PatJonesContractorsSupporting:BailitHealthPurchasing;Bi-StatePrimaryCareAssociation/CommunityHealthAccountableCare;BurnsandAssociates;DeborahLisi-Baker;Healthfirst;PolicyIntegrity;TheLewinGroup;UVMMedicalCenter/OneCareVermont;VermontMedicalSocietyFoundation;WakelyActuarial.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Noneatthistime.
March2017 8
FocusArea:PaymentModelDesignandImplementationProject:EpisodesofCare(EOCs)(ProjectComplete)
ProjectSummary:From2014throughearly2016,Vermontworkedtodevelopanepisode-basedpaymentmodelfortheMedicaidpopulationwhichwouldbeimplementedtobestcomplementotherpaymentmodelsthatarepresentlyinoperationinthestate.InApril2016,followinginternaldiscussionanddiscussionwithCMMI,Vermont’sSIMleadershipteamelectedtodiscontinuethisactivity.ProjectTimelineandKeyFacts:• June-December2014–HCi3/BrandeisengagedtoconductpreliminaryanalysesofEOCsinVermont.• January2015–Public-privatestakeholderEOCsub-groupoftheVHCIPPaymentModelsWorkGrouplaunchedto
discussthepotentialfordevelopmentofepisode-basedpaymentmodelsandanalyticstosupportdeliverysystemtransformation.
• May2015–DVHAstaffbeganMedicaid-specificanalysisofpotentialEOCs,takingintoconsiderationservicevolume,cost,andoverallvariation.
• August2015–ThreeEOCstentativelyselectedforimplementationinJuly2016.• September2015–VendorselectedtodesignMedicaid’sepisode-basedpaymentmodelfor2016launch.• November2015–PilotepisodesbroughtbeforethePaymentModelDesignandImplementationWorkGroup.• January2016–FollowingdiscussionswithCMMI,VermontdevelopednewEOCmilestones,below,whichlimit
thenumbertooneEOC.• April2016–FollowingdiscussionswithCMMI,VermontelectedtodiscontinueitsworktodevelopanEOCs.
StatusUpdate/ProgressTowardMilestonesandGoals:• InApril2016,followinginternaldiscussionanddiscussionwithCMMI,Vermont’sSIMleadershipteamelectedto
discontinuethisactivityduetoestimatedepisodelaunchdate(7/1/17,followingtheendofVermont’sSIMModelTestingperiod)andinabilitytoevaluatethemodelpriortotheendofSIM.Theinitiativehadbeenpreviouslydelayed;providerandstakeholdersupportforthisworkstreamwasneverfullyrealizedduetosignificantproviderfatigueandconcurrentcompetingpaymentreformpriorities.TheStatewillcontinueworkonIFSprogrampaymentmodelsthroughtheMedicaidVBP(MedicaidPathway)workstream.
Milestones:PerformancePeriod1:Atleast3episodeslaunchedby10/2014.PerformancePeriod1Carryover:EOCfeasibilityanalyses:
1.Analyze20episodesforpotentialinclusioninMedicaidEOCprogramby7/31/15.2.DevelopimplementationplanforEOCprogramby7/31/15.3.Convenestakeholdersub-groupatleast6timesby6/30/15.
PerformancePeriod2:Research,design,anddraftimplementationplanforoneEOCbasedoffoftheIFSprogramby6/30/16.PerformancePeriod3:N/AMetrics:CORE_Beneficiariesimpacted_[VT]_[EOC]_CommercialCORE_Beneficiariesimpacted_[VT]_[EOC]_MedicaidCORE_Beneficiariesimpacted_[VT]_[EOC]_MedicareCORE_ParticipatingProvider_[VT]_[EOC]CORE_ParticipatingOrganizations_[VT]_[EOC]CORE_PayerParticipation_[VT]AdditionalGoals: #LivesImpacted:0 #ParticipatingProviders:0KeyDocuments:EpisodesofCareSub-GroupWebpageStateofVermontLead(s):AliciaCooperContractorsSupporting:BailitHealthPurchasing;BurnsandAssociates;PacificHealthPolicyGroup.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Thisprojectiscomplete.
March2017 9
FocusArea:PaymentModelDesignandImplementationProject:Pay-for-Performance(BlueprintforHealth)
ProjectSummary:TheBlueprintforHealthprovidesperformancepaymentstoadvancedprimarycarepracticesrecognizedaspatient-centeredmedicalhomes(PCMHs),aswellasprovidingmulti-disciplinarysupportservicesintheformofcommunityhealthteams(CHTs),anetworkofself-managementsupportprograms,comparativereportingfromstate-widedatasystems,andactivitiesfocusedoncontinuousimprovement.TheBlueprintaimstobetterintegratecareforpatients,improvethehealthoftheoverallpopulation,andimprovecontroloverhealthcarecostbypromotinghealthmaintenance,prevention,andcarecoordinationandmanagement.ThisStatusReportisupdatedquarterlytoalignwiththeBlueprint’squarterlyreportstoCMMI.ProjectTimelineandKeyFacts:• 2008–BlueprintmodelpilotedintwoVermontcommunities.• 2010–VermontselectedtoparticipateinCMS’Multi-PayerAdvancedPrimaryCarePractice(MAPCP)
Demonstration,throughwhichMedicarebecomesaparticipatinginsurerwiththeBlueprint,joiningcommercialinsurersandMedicaidinprovidingfinancialsupportfortheadvancedprimarycarepractices.
• 2011–TheBlueprintexpandedandCommunityHealthTeamsimplementedacrosstheState.• 2012–TheBlueprintreportedthatlowerhealthcareexpendituresforparticipantsoffsetthepaymentsthat
insurersmadeformedicalhomesandcommunityhealthteams.• 2015–LegislatureapprovedfundingtosupportBlueprintpaymentchanges.• 2016–Continuetoimplementpaymentandqualitymeasurementchanges.• 2017–MAPCPDemonstrationends;Blueprintpractices,CHTs,andSASHteamswillcontinuetoreceiveMedicare
fundingthroughone-timefundsincludedAll-PayerModelagreement.StatusUpdate/ProgressTowardMilestonesandGoals:• TheBlueprintforHealthengagedwithitsExecutiveCommittee,DVHAandAHSleadership,andVHCIP
stakeholdersin2015todiscussmodificationstoboththeCommunityHealthTeam(CHT)andPatient-CenteredMedicalHome(PCMH)payments.Modificationsimplementedinclude:shiftingpayers’CHTpaymentstoreflectcurrentmarketshare(7/1/2015),increasingthebasepaymentstoPCMHpractices(7/1/2015forMedicaid,1/1/2016forcommercialinsurers),andaddinganincentivepaymentforregionalperformanceonacompositeofselectqualitymeasures(1/1/2016).Thelegislatureappropriated$2.4millionforMedicaidBlueprintpayments(bothCHTandPCMH)inSFY2016.QualitymeasuresselectedfortheperformanceincentivepaymentarealignedwithMedicaidandcommercialSSPsmeasuresets.
• TheBlueprinthasreachedapointwheretheprogramhasrecruitedmostoftheprimarycarepracticesinthestate,andfewnewpracticesarejoiningtheprogram.In2016,6newpracticesjoined,andcurrentlyenrolledpracticesmaintainedparticipation.In2017,theBlueprintanticipates8moreprimarycarepracticesjoining.
• Since2015,theBlueprinthasbeenworkingtoaligneffortswithACOs.(SeeRegionalCollaborations)• 2016BlueprintCommunityHealthTeamsconvenedlocalorganizationstoimplementcross-organizationcare
coordinationstrategiesacrossthestate.In2017,CHTswillsustainandcontinuetoexpandtheuseofcarecoordinationtoolsandtosupportACOcarecoordination.(SeeLearningCollaboratives.)
• MedicarebeganparticipationintheBlueprintin2011throughtheMulti-payerAdvancedPrimaryCarePractice(MAPCP)Demonstration,whichendedinDecember2016.MedicarewillcontinuetoparticipateintheBlueprintin2017throughone-timefundsincludedtheAll-PayerModelagreement;after2017,fundingfortheBlueprintwillflowthroughtheACOaspartofpopulation-basedpayments.
• OnJanuary1,2017,fourteenwomen’shealthpractices(OB/GYN,familyplanningandmidwiferypractices)beganparticipatingintheBlueprintWomen’sHealthInitiative.
Milestones:PerformancePeriod1:DevelopMedicaidvalue-basedpurchasingplanaddressingpay-for-performanceinitiatives:Medicaidvalue-basedpurchasingplandeveloped.PerformancePeriod1Carryover:
1.DesignmodificationstotheBlueprintforHealthP4Pprogram–dependentonadditionalappropriationinstatebudget.
Modificationdesigncompletedby7/1/15basedonLegislativeappropriation.2.Medicaidvalue-basedpurchasingcasestudydevelopedwithIntegratingFamilyServicesprogramcompletedby6/30/15.
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PerformancePeriod2:Roll-outofnewP4PinvestmentsforBlueprintCommunityHealthTeams(CHTs)by7/1/15andenhanceddirectpaymentstoBlueprintpracticesby1/1/16,accordingtoapprovedP4Pplan(usingnewfundsthatwereappropriatedbythelegislature).PerformancePeriod3:
1.ExpandthenumberofprovidersandbeneficiariesparticipatingintheBlueprintforHealthby6/30/17: Medicaid/commercial/MedicareprovidersparticipatinginP4Pprogramtarget:715.(Baselineasof December2015:706)
Medicaid/commercial/MedicarebeneficiariesparticipatinginP4Pprogramtarget:310,000.(BaselineasofDecember2015:309,713)
2.P4PincorporatedintoSustainabilityPlanby6/30/17.Metrics:CORE_Beneficiariesimpacted_[VT]_[APMH/P4P]_CommercialCORE_Beneficiariesimpacted_[VT]_[APMH/P4P]_MedicaidCORE_Beneficiariesimpacted_[VT]_[APMH/P4P]_MedicareCORE_ParticipatingProviders_[VT]_[APMH]CORE_ProviderOrganizations_[VT]_[APMH]CORE_PayerParticipation_[VT]AdditionalGoals: #LivesImpacted:307,658(asofDecember2016) #ParticipatingProviders:795providersacross128participatingpractices(asofDecember2016)KeyDocuments:• BlueprintforHealthWebpage
StateofVermontLead(s):BethTanzmanContractorsSupporting:Non-SIMsupported.AnticipatedRisksandMitigationStrategy:Noneatthistime.
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FocusArea:PaymentModelDesignandImplementationProject:HealthHome(Hub&Spoke)
ProjectSummary:TheHubandSpokeinitiativeisaHealthHomeinitiativecreatedunderSection2703oftheAffordableCareActforVermontMedicaidbeneficiarieswiththechronicconditionofopioidaddiction.TheHealthHomeintegratesaddictionscareintogeneralmedicalsettingsandlinksthesesettingstospecialtyaddictionstreatmentprogramsinaunifyingclinicalframework.Twopaymentsareused:bundledmonthlyrateforHubsandacapacity-basedpaymentforSpokes.ThisprogramsitswithintheBlueprintforHealth.ProjectTimelineandKeyFacts:• January2013–Hub&SpokeimplementationbeganacrossVermont.• July2013–StartdateoffirstStatePlanAmendmentforHealthHome.• January2014–StartdateofsecondStatePlanAmendmentforHealthHome.
StatusUpdate/ProgressTowardMilestonesandGoals:• Vermontiscurrentlyassessingandexpandingstatecapacitytocollectandreportonperformancemetrics.• Accesstotreatmentissteadilyexpanding,from2,867MedicaidbeneficiariesreceivingtreatmentinJanuary
2013to5,883inFebruary2017.• December2015baselineforprovidersprescribingto≥10patientsincludedinPerformancePeriod3milestone
(below)includesduplicateswhereprovidersareprescribinginmultipleregions;thede-duplicatedcountis67.• Programimplementationandreportingareongoing.
Milestones:PerformancePeriod1:HealthHomes.PerformancePeriod1Carryover:State-wideprogramimplementation.
1.ImplementHealthHomeaccordingtoHealthHomeStatePlanAmendmentandfederalplanfor2015.2.ReportonprogramparticipationtoCMMI.
PerformancePeriod2:Reportingonprogram’stransitionandprogress:QuarterlyreportingofprogramprogresstoCMMI,VHCIPstakeholders.PerformancePeriod3:
1.ExpandthenumberofprovidersandbeneficiariesparticipatingintheHealthHomeprogramby6/30/17:NumberofprovidersparticipatinginHealthHomeprogramtarget:75MDseachprescribingto>=10patients.(BaselineasofDecember2015:67*Notethisfigureiscorrectedfrompreviousversionsbecausethepreviousfigurewasnotde-duplicated)NumberofbeneficiariesparticipatinginHealthHomeprogramtarget:2,900Hub+2,300Spoke=5,200totalpatients.(BaselineasofDecember2015:5,179)
2.HealthHomeprogramincorporatedintoSustainabilityPlanby6/30/17.Metrics:CORE_ProviderOrganizations_[VT]_[HH]CORE_ParticipatingProviders_[VT]_[HH] AdditionalGoals: #LivesImpacted:5,883(asofFebruary2017) #ParticipatingProviders:199+5Hubs(asofFebruary2017)KeyDocuments:• BlueprintforHealthWebpage
StateofVermontLead(s):BethTanzmanContractorsSupporting:Non-SIMsupported.AnticipatedRisksandMitigationStrategy:Noneatthistime.
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FocusArea:PaymentModelDesignandImplementationProject:AccountableCommunitiesforHealth
ProjectSummary:Thiseffortseekstoalignprogramsandstrategiesrelatedtointegratedcareforindividualsandcommunity-widepreventioneffortstoimprovehealthoutcomeswithinageographiccommunity.PhaseIofthiswork(2015)focusedonresearchtofurtherdefinetheAccountableCommunitiesforHealth(ACH)modelandidentifycoreelements.PhaseIIbroughttogethermulti-disciplinaryteamsfromcommunitiesacrossthestateinanAccountableCommunitiesforHealthPeerLearningLaboratory,whichsoughttosupportparticipatingcommunitiesinincreasingtheircapacityandreadinessacrosstheninecoreelementsoftheACHmodel.ThePeerLearningLabcurriculumutilizedin-personanddistancelearningmethodstosupportpeerlearning,aswellascommunityfacilitationtosupporteachcommunity’sdevelopment.Afinalreportfromthisprojectwilldocumentfindingsandlessonslearned,andwillincluderecommendationstoinformfutureStatedecision-making,focusingonwhatinfrastructureandresourcesareneededatthecommunity/regionallevelandtheStatelevel.ProjectTimelineandKeyFacts:• Fall2014–PopulationHealthWorkGroupexpressedinterestinestablishinganACHinVermont.• January-June2015–ACHPhaseI:ResearchtodefineACHmodelandidentifycoreconcepts.• January-February2016–ACHPeerLearningLaboratorysoftlaunch;10communitiesfromaroundVermontwere
acceptedforparticipation.• May2016–ACHPeerLearningLaboratoryNeedsAssessmentsurveyreleased.• June2016–ACHPeerLearningLaboratoryKick-OffWebinar;In-PersonLearningSession#1(of3).• September2016–ACHPeerLearningLaboratoryIn-PersonLearningSession#2(of3).• January2017–ACHPeerLearningLaboratoryIn-PersonLearningSession#3(of3).• March2017–ACHPeerLearningLaboratoryfinalreportcompleted.• BeyondMarch2017–TheVermontDepartmentofHealth,BlueprintforHealth,andOneCareVermontwill
conveneACHPeerLearningLabcommunitiesapproximately3timesperyeartosupportcontinuedcommunitygrowthonACHcoreelementsandpeerlearningacrosscommunities.
StatusUpdate/ProgressTowardMilestonesandGoals:• ThePeerLearningLabhadasoftlaunchinJanuary2016withthereleaseofrecruitmentmaterialsandan
informationalwebinar.TencommunitieswereselectedtoparticipateinFebruary.Akick-offwebinarwasheldonJune1.
• Threein-personconveningswithparticipatingcommunitieswereheldinJuneandSeptember2016,andJanuary2017.LocalfacilitationtosupportcommunitiesindevelopingACHcompetenciesalsobeganinJuneandwillcontinuethroughtheconclusionofthisphaseofworkinMarch2017.
• WorkwiththeBlueprintforHealth,AccountableCareOrganizations(ACOs),andotherpartnerstoidentifyopportunitiestoimprovepopulationhealththroughbetterintegrationofclinicalservices,publichealthprograms,andcommunitybasedservicesatboththepracticeandthecommunitylevelsisongoing,asareeffortstoincorporateAccountableCommunitiesforHealthintoVermont’sSIMSustainabilityPlan.
• TheVermontDepartmentofHealth,BlueprintforHealth,andOneCareVermontwillcontinuetoconveneACHPeerLearningLabcommunitiesapproximately3timesperyeartosupportcontinuedcommunitygrowthonACHcoreelementsandcontinuedpeerlearningacrosscommunities.
Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:Feasibilityassessment–researchACHdesign.
1.ConvenestakeholderstodiscussACHconceptsatleast3timestoinformreport.2.ProduceAccountableCommunityforHealthreportby7/31/15.
PerformancePeriod2:Feasibilityassessment–dataanalytics:1.DiscussionandplanningofinvestmentsrelatedtoACHfeasibilitybasedonresearch/reportby11/1/15.2.Design/creationofACHlearningsystemforall14VermontHealthServiceAreasby1/31/16.3.StartrolloutACHlearningsystemtoatleast3healthserviceareasby2/1/16.4.Researchforimplementationofapilotincorporatingapaymentchange(dataanalysis,financialanalysis,stakeholderparticipationanalysis)foratleast1Vermontregionby2/1/16.
PerformancePeriod3:
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1.ContinueimplementationofACHlearningsystem(ACHPeerLearningLaboratory)to10participatingcommunities.2.DevelopACHImplementationPlanbasedonlessonslearnedfromACHPeerLearningLaboratoryby6/30/17.3.ACHImplementationPlanincorporatedintoSustainabilityPlanby6/30/17.
Metrics:CORE_ProviderOrganizations_[VT]_[ACO]_CommercialCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicareCOREParticipatingProviders_[VT]_[ACO]_CommercialCOREParticipatingProviders_[VT]_[ACO]_MedicaidCOREParticipatingProviders_[VT]_[ACO]_MedicareCORE_PayerParticipation_[VT]AdditionalGoals: #LivesImpacted:TBD #ParticipatingProviders:TBDKeyDocuments:• IntegratingPopulationHealthinVHCIP• ACO/TACO/ACH• AccountableCommunitiesforHealth,OpportunitiesandRecommendations• AccountableCommunitiesforHealthPeerLearningLaboratoryRecruitmentPacket
StateofVermontLead(s):HeidiKlein,SarahKinslerContractorsSupporting:BailitHealthPurchasing;BurnsandAssociates;PreventionInstitute;PublicHealthInstitute.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:• Lackofcoordinationcouldresultinsiloedimprovementinitiativesacrossclinicalcare,socialservices,and
primaryprevention.o KeyprojectstaffandcontractorsareworkingwithStateandprivatesectorleadersengagedinrelated
initiatives.ContinuedleadershipfromVDH,Blueprint,andOneCareVermontwillensureinitiativescontinuetoalignafterSIMends.
March2017 14
FocusArea:PaymentModelDesignandImplementationProject:ProspectivePaymentSystem–HomeHealth(ProjectComplete)
ProjectSummary:Asaresultofstakeholdersupportinthestate,legislationwaspassedin2015requiringthatDVHA,incollaborationwiththeState’shomehealthagencies,developaprospectivepaymentsystem(PPS)forhomehealthpaymentsmadebyDVHAundertraditionalMedicaid(exclusiveofwaivers)tobeputinplacebyJuly1,2016.Duringtheir2016session,Vermont’sLegislatureisconsideringadelayinimplementationofthismodeluntilJuly1,2017,attherequestofhomehealthprovidersaroundthestate.InApril2016,afterinternaldiscussionanddiscussionwithCMMI,Vermont’sSIMprojectsuspendedthiseffortinresponsetothischangeandeliminatedthismilestoneinPerformancePeriod3.ProjectTimelineandKeyFacts:• May2015–EnablinglegislationpassedinVermont’slegislature.• June2015–PlanningforHomeHealthPPSbegan.• April2016–AfterinternaldiscussionanddiscussionwithCMMI,Vermont’sSIMprojectsuspendedthiseffortin
responsetothischangeandeliminatedthismilestoneinPerformancePeriod3.StatusUpdate/ProgressTowardMilestonesandGoals:• AsaresultofongoingcollaborationbetweenDVHAandVermont’shomehealthagencies,partnersreached
consensusthatthePPSwouldbecomprisedofepisode-basedpayments(mostlikely60daysinlength,similartoMedicare)thatwillbeadjustedforcaseacuity.DVHAdevelopedfiveacuitygroupingsandpresentedthemtotheproviderassociationforfeedback.Basedonthatfeedback,acuityadjustmentfactorswerefinalizedandafiscalimpactwasdevelopedforeachprovider.
• DVHAandprovidersmettoreviewthepotentialfiscalimpactofthemodelchange.Basedonresultsoftheseanalyses,itwasagreedthatmoretimewasneededtodevelopanincrementalapproachtotheimplementationoftheprospectivepaymentsystem.
• Duringtheir2016session,Vermont’sLegislatureconsideredadelayinimplementationofthismodeluntilJuly1,2017,attherequestofhomehealthprovidersaroundthestate.InApril2016,afterinternaldiscussionanddiscussionwithCMMI,Vermont’sSIMprojectsuspendedthiseffortinresponsetothischangeandeliminatedthismilestoneinPerformancePeriod3.
Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:N/APerformancePeriod2:
1.CreationofaprojectplanandbeginPhase1activitiesasrequiredbyprojectplanforPPS-HHby12/31/15.2.DesignPPSprogramforhomehealthforlaunch7/1/16.
PerformancePeriod3:N/AMetrics:CORE_ProviderOrganizations_[VT]_[ACO]_CommercialCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicareCOREParticipatingProviders_[VT]_[ACO]_CommercialCOREParticipatingProviders_[VT]_[ACO]_MedicaidCOREParticipatingProviders_[VT]_[ACO]_MedicareCORE_PayerParticipation_[VT]AdditionalGoals: #LivesImpacted:N/A #ParticipatingProviders:N/AKeyDocuments:StateofVermontLead(s):AaronFrenchContractorsSupporting:N/AAnticipatedRisksandMitigationStrategy:Thisprojectiscomplete.
March2017 15
FocusArea:PaymentModelDesignandImplementationProject:All-PayerModel
ProjectSummary:TheVermontAll-PayerACOModelbuildsonexistingall-payerpaymentmodelstobettersupportandpromoteamoreintegratedsystemofcareandasustainablerateofoverallhealthcarecostgrowthinVermont.Value-basedpaymentsthatshiftriskontohealthcareprovidersandthatarealignedacrossallpayersencouragecollaborationacrossthecarecontinuumandcanresultinbetterhealthoutcomesforVermonters.ThroughthelegalauthorityoftheGreenMountainCareBoard(GMCB)andfacilitatedbyanAll-PayerAccountableCareOrganizationModelAgreementwithCMMI,thestatecanenablethealignmentofcommercialpayers,Medicaid,andMedicareinanAdvancedAlternativePaymentModel.Specifically,theStatewillapplytheNextGenerationACOpaymentmodelacrossallpayerswithmodifications,withall-payerratessetbytheGMCBtoenablethemodel.ThefocusontheACOandexistingCMSACOprogramming,alongwithVermont’sstrongstakeholdernetwork,SIMinvestments,andthecurrentSSPprogram,isatimelyandrealisticevolutionofVermont’smulti-payerreform.Eventually,anintegratedACOandAll-PayerModelinVermontcouldattractandinvolvethevastmajorityofpeople,payers,andproviders.ProjectTimelineandKeyFacts:VermontstaffisengagedinongoingdiscussionswithCMMIstaff.• 2015–AchievedalignmentwithCMMIontermsheetthatcontainskeyelementsoftheAPM,includinghigh-
levelmodelsforratesetting,financialtargets,waivers,ACO,andqualityandperformancemeasurement.• 2015-ongoing–Stakeholderoutreachandpublicprocesstovettermsheetandpotentialmodeldesign.• November2015-March2016–Furtherworkonallphasesofproject,includingACOcapacitydevelopment,rate-
setting,andqualitymeasurementmethodologies.Beginimplementationoffunctionalityrequiredtoensureoperationalreadiness.
• March15,2016-January1,2017–CapacitybuildingtoprepareforimplementationofanAPM.• April15,2016–ReachedconsensuswithCMMIonmajorelementsrequiringclearance.• April-September2016–ContinuedtorefineelementsnecessaryforinclusioninanAPMagreement.• September2016-October2016–AgreementwithCMMIonAPMagreementachieved.Draftagreementpublicly
releasedforcomment,withGMCBholdingmeetingsandjointpublicforumsonthistopicinOctober.AgreementdocumentandalignedMedicaid1115waiverrenewalsignedattheendofOctober.
• January1,2017-December31,2017–PilotyearforVermontMedicaidNextGeneration(VMNG)ACOprogram.• September2016-January1,2018–Beginmodelandprepareforfirstyearoffinancialandqualitymeasure
accountability.StatusUpdate/ProgressTowardMilestonesandGoals:• AgreementwithCMMI:
o SOVproposedatermsheettoCMMIonJanuary25,2016.Thetermsheetsetoutthebasicoutlineforapotentialall-payermodelagreement,includingthelegalauthorityofthestatetoenterintosuchanagreement,theperformanceperiodfortheagreement,waiversnecessarytofacilitatepaymentchangeandadditionalcoveredservices,datasharing,andanevaluationofthedemonstration.
o ThestakeholderoutreachandpublicprocesstovetthetermsheetandpotentialmodeldesignbeganinJanuary2016,withpublicmeetingsatGMCBtodiscusstheproposedtermsheetonJanuary28and29.Thehearingswerewellattendedbystakeholders.Concurrently,SOVstafftestifiedbeforerelevantlegislativecommitteestoexplainthetermsheetandprospectivemodeltoVermont’spolicymakers.
o AgreementontermswasreachedinSeptember2016.VermontdistributedthedraftagreementandcompaniondocumentstoabroadgroupofstakeholdersonSeptember28andheldaseriesofGMCBmeetingsandjointpublicforumswiththeAdministrationtoexplainthedraftagreementandgatherpubliccommentinOctober.TheagreementwassignedonOctober27.StaffandfederalpartnersalsoworkedtogethertoensurealignmentbetweentheAll-PayerModelandVermont’s1115Medicaidwaiverrenewal,alsofinalizedinlateOctober.
• VermontMedicaidNextGenerationACOProgram:o OnApril7,theState’sMedicaidagencypublishedanRFPseekingacontractwitharisk-bearingACOthat
utilizesaNextGenerationpaymentmodelinanticipationoftheAll-PayerModel.Fourentitiessubmittedlettersofintent,withbidsdueinearlyJune.VermontselectedOneCareVermontasthesuccessfulbidder.
o InDecember2016,VermontMedicaidconductedareadinessreviewtoensurethatOneCareVermontwasoperationallycapableofparticipatinginaMedicaidversionoftheNextGenerationACOprogram.This
March2017 16
includedbothseveralweeksofdeskauditsandafullweekofin-personreview.OneCarepassedthereadinessreview,with76%ofitemscomplete;100%ofitemswerecompletebytheendofMarch2017.
o VermontMedicaidandOneCareVermontsignedacontractinFebruarytolaunchtheVermontNextGeneration(VMNG)ACOprogramforcalendaryear2017.TheprogramisalignedwiththeCMSNextGenerationACOprogram.Ithasthefollowingfeatures:nearly30,000attributedlives,apaymentmodelalignedwithNextGenerationPaymentModel4,upsideanddownsideriskfortheACO,qualitymeasuresalignedwiththeAPMagreement,andaportionofpaymentcontingentonquality.Thecontractcanbeextendeduptofouradditionalyears.
o TheGreenMountainCareBoard(GMCB)conductedaMedicaidRateCasewheretheyreviewedtheall-inclusivepopulationbasedpaymenttobepaidbyVermontMedicaidtotheACOOneCareVermont.GMCBwillconductsimilarreviewsduringtheperformanceyears1-5oftheAll-PayerModel.
o StaffareworkingtoprepareMedicaidfortheAll-PayerModelinitsroleasapayer,includingdevelopingreportstotrackACOandStateperformanceinimplementingthemodel.
• ACOMerger:o OnMay1,representativesfromCommunityHealthAccountableCare(CHAC),Healthfirst/Vermont
CollaborativePhysicians(VCP),andOneCareVermontAccountableCare(OneCare)votedunanimouslytoformaunifiedACO(“VermontCareOrganization”(VCO))byJune1,2016;VCOwillactasanumbrellaorganizationthatwouldcreateaunifiedstructuretocoordinatetheworkofAccountableCareOrganizationsinVermont.
• All-PayerModelImplementation:o InMay2016,GovernorShumlinsignedAnactrelatingtoimplementinganall-payermodelandoversightof
accountablecareorganizationsintolawasAct113of2016.ThelawtaskstheGreenMountainCareBoardwithformalstateregulationofaccountablecareorganizations.
o TheGreenMountainCareBoardcontinuestoprepareforAll-PayerModelimplementation,includingdevelopingregulatoryoversightandpolicydevelopmentmechanisms.ThisregulatorycapacitybuildingincludescreatingtheframeworkforreviewingaMedicaidall-inclusivepopulation-basedpaymenttoanACOin2017andforallpayersbeginningin2018.
o TheFundingOpportunityAnnouncementforStart-UpFundinginSupportoftheVermontAll-PayerACOModelCooperativeAgreement,worthupto$9.5million,wasreleasedinlateNovember2016.TheStatesubmittedanon-competitiveapplicationforthesefundsinDecember2016.VermontwasawardedthisCooperativeAgreementonMarch2,2017.
o InNovember2016,theAgencyofHumanServicesreleasedaprocessbywhichtheStatewillacceptproviderapplicationsforDeliverySystemReformInvestmentfunds,capacityforwhichwasbuiltintoVermont’srenewed1115MedicaidGlobalCommitmentWaiver.TheStateheldaninformationsessionandreleasedawebinarregardingthisapplicationprocessinDecember.ThenewAdministrationisreviewingtheprocessbywhichtheseinvestmentsaremade.
• VermontsubmittedanapplicationtotheCPC+programonJune8.VermontsubmittedthisapplicationasaplaceholderincasetheAll-PayerModeldoesnotcometofruition.CMSdeniedthisapplicationonJuly28.
Milestones–All-PayerModel:PerformancePeriod1:N/APerformancePeriod1Carryover:N/APerformancePeriod2:
1.Researchfeasibility,developanalytics,andobtaininformationtoinformdecision-makingwithCMMI.2.WorkwithCMMIonmutually-agreedupontimelinefor2016decision-makingby12/31/15.
PerformancePeriod3:1.Ifnegotiationsaresuccessful,assistwithimplementationasprovidedforinAPMagreementthroughendofSIMgrant.2.Contributetoanalyticsrelatedtoall-payermodelimplementationdesignthroughendofSIMgrant.3.All-PayerModelincorporatedintoSustainabilityPlanby6/30/17.
Milestones–StateActivitiestoSupportModelDesignandImplementation–GMCB:PerformancePeriod1:N/A
March2017 17
PerformancePeriod1Carryover:Identifyqualitymeasurementalignmentopportunities.(inanothersectionpreviously–thequalitysection):
1.ReviewnewBlueprint(P4P)measuresrelatedtonewinvestmentsby7/1/15.PerformancePeriod2:
1.ResearchandplanningtoidentifythecomponentsnecessaryforAPMregulatoryactivitiesby6/30/16.2.SpecificregulatoryactivitiesandtimelinearedependentondiscussionswithCMMI.
PerformancePeriod3:N/A(milestonesinthiscategoryintegratedintoAll-PayerModelforPerformancePeriod3)Metrics:CORE_ProviderOrganizations_[VT]_[ACO]_CommercialCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicareCOREParticipatingProviders_[VT]_[ACO]_CommercialCOREParticipatingProviders_[VT]_[ACO]_MedicaidCOREParticipatingProviders_[VT]_[ACO]_MedicareCORE_PayerParticipation_[VT]AdditionalGoals:ThegoalisfortheAPMtoincludethemaximum,prudentamountofservices,providers,andspending.Generally,theAPMisbasedoncoveredservices.TheagreementincludesMedicarePartAandPartBspending,andtheircommercialandMedicaidequivalents,inthemodel.Thisisthemajorityofstatehealthcarespending.Theprojectalsoaimsformaximumproviderparticipation.GivencurrentACOparticipation,thereisasignificantopportunitytoincludeallhospitalsinVermontalongwithDartmouth-HitchcockMedicalCenterinNewHampshire.Hospitalsemploy~2/3ofphysiciansinVermont.Additionally,ACOrostersincludemanyindependentdoctorsandthestate’sFQHCs. #LivesImpacted:29,103throughVermontMedicaidNextGenerationACOPilot(asofFebruary2017) #ParticipatingProviders:1,836throughVermontMedicaidNextGenerationACOPilot(asofFebruary2017)KeyDocuments:• All-PayerACOModelAgreement• All-PayerModelSummary• All-PayerModelFAQs
StateofVermontLead(s):MichaelCosta,EnaBackusContractorsSupporting:BailitHealthPurchasing;BurnsandAssociates;HealthManagementAssociates.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:• ThetransitiontoanewfederalAdministrationinJanuary2017createdrisk.
o TheAPMagreementwassignedinOctober2016.Sincethen,boththestateandfederaladministrationshavechanged.InVermont,theAdministrationhastakenspecificandtimelystepstowardimplementation.VermontwillworkwithfederalpartnerstoensureasseamlessatransitionaspossiblewithrespecttotheAll-PayerModel,acknowledgingthatsomeuncertaintyisinevitableduringthistime.
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FocusArea:PaymentModelDesignandImplementationProject:MedicaidValue-BasedPurchasing(MedicaidPathway–MentalHealth/SubstanceUse)1
ProjectSummary:TheMedicaidPathwayisacompanionprojecttotheAll-PayerModelthatseekstoacceleratepaymentanddeliverysystemreformforprovidersandservicesnotinitiallysubjecttotheproposedfinancialcapsoftheAll-PayerModel,suchasLTSS,mentalhealth,substanceusedisorder(SUD)servicesandothers.ThisworkstreamfocusesonmentalhealthandSUDproviders,incorporatingpreviousworktoassessfeasibilityofcurrentmentalhealthandSUDspendingwithintheAgencyofHumanServices.In2016,theStateconvenedprovidersfromeachthesesectorsalongwithotherkeypartnerstodeterminehowbesttoserveVermontersthroughamoreintegratedcontinuumofmentalhealth,SUD,anddevelopmentalservices.ProjectTimelineandKeyFacts:• Fall2015–Leveragedexistingcontractstostartfeasibilitystudy.• December2015–ImplementationplanforpresentationandapprovalbyAHSleadership.• January-March2016–Stakeholdergroupconvenedandidentificationofkeyprojecttaskscompleted.• March-June2016–Developmentofpotentialpaymentmodelandimplementationplanwithstakeholders.• July-December2016–Operationalplanningfornewpaymentmodelwithstakeholders.• January2017–InternalplanningtorefineprojectfocusinlinewithStategoals.
StatusUpdate/ProgressTowardMilestonesandGoals:• OngoingmeetingswithleadershipfromtheAgencyofHumanServicesandmembersoftheprovidercommunity.• InSeptember2016,anInformationGatheringProcesswasreleasedtosolicitfeedbackonproposedreforms.
Fourresponseswerereceived;andtheStatereleasedaresponsetofeedbackinNovember2016.• InNovember2016,asurveywasdistributedtoconsumersandadvocates;17responseswerereceived.• InDecember2016,legislativereportsinaccordancewithAct113,Sec.11andAct113,Sec.12weresubmittedby
theAgencyofHumanServicestotheSenateCommitteeonHealthandWelfare,theHouseCommitteeonHealthCare,andtheHouseCommitteeonHumanServices.
Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:N/APerformancePeriod2:N/APerformancePeriod3:
1.MentalHealthandSubstanceAbuse:Basedonresearchandfeasibilityanalysis,designanalternativetofee-for-service,forMedicaidmentalhealthandsubstanceuseservicesby12/31/16.Developimplementationtimelinebasedonpaymentmodeldesignandoperationalreadinessby12/31/16.2.OtherMedicaidVBPActivities:EngageinresearchandfeasibilityanalysistosupportadditionalMedicaidValue-BasedPurchasingactivities.
Metrics:CORE_Beneficiariesimpacted_[VT]_[ACO]_MedicaidCORE_ParticipatingProvider_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidAdditionalGoals: #LivesImpacted:N/A #ParticipatingProviders:N/AKeyDocuments:• InformationGatheringProcess• InformationGatheringProcessStakeholderFeedbackandStateResponse–November2016• StateofVermontGoals:MedicaidPathway–DAs,SSAs,andPreferredProviders–September2016
StateofVermontLead(s):GeorgiaMaheras,SelinaHickmanContractorsSupporting:BailitHealthPurchasing,BurnsandAssociates,PacificHealthPolicyGroup.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Noneatthistime.
1Thisworkstreamconsolidatesmilestonesfromtwopreviousworkstreams:ProspectivePaymentSystem–DesignatedMentalHealthAgenciesandMedicaidValue-BasedPurchasing–MentalHealthandSubstanceAbuse.
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FocusArea:PaymentModelDesignandImplementationProject:MedicaidValue-BasedPurchasing(MedicaidPathway–LTSS/ChoicesforCare)
ProjectSummary:TheMedicaidPathwayisacompanionprojecttotheAll-PayerModelthatacceleratespaymentanddeliverysystemreformforprovidersandservicesnotinitiallysubjecttotheproposedfinancialcapsoftheAll-PayerModel,suchasLTSS,mentalhealth,substanceusedisorderservicesandothers.Thisworkstreamfocusesondeliverysystemintegrationandpaymentreformwiththegoalofimprovingoutcomesandqualityofcareforpeoplewhoreceivelong-termservicesandsupports,inparticularthroughVermont’sChoicesforCareprogram.ChoicesforCareisanationallyrecognizedMedicaidprogramthatservesbothnursinghomeresidentsandthosereceivinghome-andcommunity-basedservices.Savingsfromdecreasedinstitutionalutilizationhelptofundcommunity-basedservicesforparticipantswhoqualifyfor“nursinghome-levelofcare.”Thisprojecthasexploredvalue-basedpaymentmodelstoachievetheseimprovements.TheSt.JohnsburypilotcompleteditsresearchandfeasibilityanalysesinMarch2016(seeStatusUpdatebelow).ProjectTimelineandKeyFacts:• July2015-December2015–Sub-GroupconvenedtoresearchimplementationofaSt.Johnsburypilotprogram.• January2016–ProposedSt.JohnsburyprojectplanpresentedtoVHCIPleadershipandstakeholders.• February-March2016–ContinuedresearchandfeasibilityanalysesforapotentialSt.Johnsburypilot.• May-December2016–LTSS/ChoicesforCareMedicaidPathwaySubgroupformed.Subgroupisworkingto
identifygoalsandscope,discussdeliverysystemandpaymentmodels,developaqualityandoversightframework,promote,andoverseepilotproject(s),andidentifynecessaryresourcesandpolicychanges.
• January2017–InternalplanningtorefineprojectfocusinlinewithStategoals.StatusUpdate/ProgressTowardMilestonesandGoals:• IntensiveplanningandstakeholderengagementbeganinJune2016.• ResearchforoneVermontregion,St.Johnsbury,wascompletedinMarch2016.
Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:N/APerformancePeriod2:N/APerformancePeriod3:
1.MentalHealthandSubstanceAbuse:Basedonresearchandfeasibilityanalysis,designanalternativetofee-for-service,forMedicaidmentalhealthandsubstanceuseservicesby12/31/16.Developimplementationtimelinebasedonpaymentmodeldesignandoperationalreadinessby12/31/16.2.OtherMedicaidVBPActivities:EngageinresearchandfeasibilityanalysistosupportadditionalMedicaidValue-BasedPurchasingactivities.
Metrics:CORE_ProviderOrganizations_[VT]_[ACO]_CommercialCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicareCOREParticipatingProviders_[VT]_[ACO]_CommercialCOREParticipatingProviders_[VT]_[ACO]_MedicaidCOREParticipatingProviders_[VT]_[ACO]_MedicareCORE_PayerParticipation_[VT]AdditionalGoals: #LivesImpacted:N/A #ParticipatingProviders:N/AKeyDocuments:LTSS/CFCMedicaidPathwayGoals,Principles,andObjectives.StateofVermontLead(s):BardHillContractorsSupporting:BailitHealthPurchasing,PHPGToviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:• ChangestotheCFCsystemmayrequirelegislativeapproval.
March2017 20
FocusArea:PaymentModelDesignandImplementationProject:StateActivitiestoSupportModelDesignandImplementation–Medicaid
ProjectSummary:ForallMedicaidpaymentmodelsthataredesignedandimplementedaspartofVermont’sStateInnovationModelgrantactivity,thereareanumberofMedicaid-specificstateactivitiesthatmustoccur.TheseactivitiesensurethatVermontMedicaid’sSIM-supportedactivitiesareincompliancewithitsMedicaidStatePlananditsMedicaid1115waiver,andthatnewlyestablishedprogramswillbemonitoredfortheirimpactonMedicaidbeneficiaries.ProjectTimelineandKeyFacts:• February2014–VermontsubmittedStatePlanAmendmenttoCMSforYear1SSP.• July2014–EstablishedcallcenterforMedicaidbeneficiarieswithqueriesorconcernsspecificallyabouttheSSP.• July2014–Establishedpermissionsandprotocolstobeginmonthlydata-sharingbetweenMedicaidandACOs
participatinginSSP;establishprocessfortrackingACOandMedicaidcompliancewithmonthlycontractualobligations.
• June2015–VermontreceivedStatePlanAmendmentapprovalfromCMSforYear1SSP.• August2015–VermontsubmittedStatePlanAmendmenttoCMSforYear2SSP.• September2015–VermontreceivedStatePlanAmendmentapprovalfromCMSforYear2SSP.• March2016–VermontsubmittedStatePlanAmendmenttoCMSforYear3SSP.• June2016–VermontreceivedStatePlanAmendmentapprovalfromCMSforYear3SSP.
StatusUpdate/ProgressTowardMilestonesandGoals:• BothYear1and2SSPStatePlanAmendmentswereapprovedin2015;theYear3SSPStatePlanAmendment
wasapprovedin2016.• Beneficiarycall-centerisoperationalandwillcontinuethroughprogramduration.• ACOdatasharingisongoing.• FrailEldersprojectrecommendationspresentedtoVHCIPworkgroupsandSteeringCommitteeinJune2016.
Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:Pursuestateplanamendmentsandotherfederalapprovalsasappropriateforeachpaymentmodel(SSPSPA);ensuremonitoringandcomplianceactivitiesareperformed.Ensurebeneficiarieshaveaccesstocall-centerasappropriate.
1.ObtainSSPYear1StatePlanAmendmentby7/31/15.2.ProcurecontractorforSSPmonitoringandcomplianceactivitiesby4/15/15.3.Procurecontractorfordataanalyticsrelatedtovalue-basedpurchasinginMedicaidby9/30/15.4.EnsurecallcenterservicesareoperationalforMedicaidSSPforSSPYear2.
PerformancePeriod2:Pursuestateplanamendmentsandotherfederalapprovalsasappropriateforeachpaymentmodel(SSPSPA,EOCSPA);ensuremonitoringandcomplianceactivitiesareperformed.Ensurebeneficiarieshaveaccesstocall-centerasappropriate:
1.EnsureappropriatecustomerservicesupportsareinplaceforMedicaidSSPprogramfor2016by11/1/15.2.ObtainSPAforYear2oftheMedicaidSharedSavingsProgramby3/31/15.3.CreatedraftSPAdocumentsforYear1oftheEOCprogramby4/1/16.4.ExecuteYear1andYear2commercialandMedicaidmonitoringandcomplianceplansthroughoutPerformancePeriod2accordingtothepredeterminedplan.5.DevelopmonitoringandcomplianceplanforYear1EOCsby6/30/16.6.DesignmodificationstoexistingIntegratedFamilyServices(IFS)Programsoitcanexpandtoatleastoneadditionalcommunityon7/1/16.7.ResearchanddesignrelatedtoFrailElders(timelinedependentuponfederalcontractapproval)–finalrecommendationsby6/30/16.
PerformancePeriod3:Pursuestateplanamendmentsandotherfederalapprovalsasappropriateforeachpaymentmodel;ensuremonitoringandcomplianceactivitiesareperformed:
1.ObtainSPAforYear3oftheMedicaidSharedSavingsProgramby12/31/16.2.ExecuteYear3commercialandMedicaidmonitoringandcomplianceplansaccordingtothepredeterminedplanthrough6/30/17.
Metrics:
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CORE_Beneficiariesimpacted_[VT]_VTEmployeesCORE_Beneficiariesimpacted_[VT]_[ACO]_CommercialCORE_Beneficiariesimpacted_[VT]_[ACO]_MedicaidCORE_Beneficiariesimpacted_[VT]_[ACO]_MedicareCORE_ParticipatingProvider_[VT]_[ACO]_CommercialCORE_ParticipatingProvider_[VT]_[ACO]_MedicaidCORE_ParticipatingProvider_[VT]_[ACO]_MedicareCORE_ProviderOrganizations_[VT]_[ACO]_CommercialCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicareAdditionalGoals: #LivesImpacted:N/A #ParticipatingProviders:N/AKeyDocuments:• FrailEldersProjectWebsite
StateofVermontLead(s):AliciaCooperContractorsSupporting:BailitHealthPurchasing;BurnsandAssociates;WakelyActuarial.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Noneatthistime.
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FocusArea:PracticeTransformation
FocusArea:PracticeTransformationProject:LearningCollaboratives(ProjectComplete)
ProjectSummary:TheIntegratedCommunitiesCareManagementLearningCollaborativeisaHealthServiceArea-levelrapidcyclequalityimprovementinitiative.ItisbasedonthePlan-Do-Study-Act(PDSA)qualityimprovementmodel,andfeaturesin-personlearningsessions,webinars,implementationsupport.TheCollaborativefocusesonimprovedcross-organizationcaremanagementforat-riskpopulations;however,theultimategoalistodevelopthisapproachpopulation-wide.TheSIM-fundedportionofthisprojectiscompleteasofDecember2016;theprojecttransitionedtothelocalcommunitieswithsupportfromtheBlueprintforHealthandVCOasofJanuary2017.ProjectTimelineandKeyFacts:• November2014–Kick-offwebinarforRound1communities(3communitiestotal).• January2015–Firstin-personlearningsessionheldwith~90peopleinattendance,featuringnationalexperts
fromtheCamdenCoalitionofHealthcareProviders.• February-December2015–Alternatingmonthlywebinarsandin-personlearningsessionsforRound1
communities.• April2015–ProposedexpansionoftheLearningCollaborativetoadditionalcommunities.• July2015–Kick-offwebinarforRound2communities(8additionalcommunities).• November2015–Secondin-personlearningsessionforRound2communities.• October2015-September2016–Alternatingmonthlywebinarsandin-personlearningsessionsforRound2.• September2016–Round1andRound2communitiesmergedforajointsessionwithafocuson“Keepingthe
SharedPlanofCareAliveUnderDynamicandChallengingSituations.”• October-December2016–Transitioncollaborativetopost-SIMstructurewithembeddedleadershipatthe
communitylevel,supportedbyVCOandBlueprintforHealthleadership.Continuetoidentifyopportunitiesforstate-widepeersupport,sharingandlearningtocontinue.
StatusUpdate/ProgressTowardMilestonesandGoals:• TheLearningCollaborativeworkstoengageasmanypatient-facingcareproviderswithineachcommunityas
possible,includingnurses,carecoordinators,socialworkers,mentalhealthclinicians,physicians,andothers,fromabroadspectrumofhealth,communityandsocialserviceorganizationsthatincludesprimarycarepractices,communityhealthteams,homehealthagencies,mentalhealthagencies,AreaAgenciesonAging,housingorganizations,AgencyofHumanServices,socialserviceorganizations,andothers.
• Participantsconvenedforatleastfourin-personlearningsessionsandmultiplewebinars,aswellasregularlocalmeetingstosupportwork.
• Thefirstcohortof3communitiesjoinedtheLearningCollaborativeinNovember2014.Anadditionalcohortof8communitiesjoinedtheLearningCollaborativeinNovember2015.
• TheLearningCollaborativetoolkitiscompleteandispubliclypostedtotheBlueprintforHealthwebsite,andwillbepostedtotheVHCIPwebsiteaswell.Thetoolkitwillbereviewedandupdatedonanadhocbasisinthefuturetoensureincorporationofnewtools,improvementstoexistingtools,andalignmentwithACOtoolsandtrainings.Astate-widecarecoordinationtoolkittrainingwasheldinDecemberforprovidersacrossthestate.
• TwowebinarswereconductedinDecember:“CommunityProgresswithCareNavigator”offeredanopportunityforthepilotcommunitiestosharetheirlearningsandprogressinbuildingupontheworkflowsoftheICCMLCastheyimplementCareNavigator;“AddressingStatePrivacyConcernstoPromoteInteroperability”addressedquestionsandconcernsregardingsharinginformationacrosscareteams.
• BlueprintforHealthandVCOstaffcontinuetomeettoidentifylearningopportunitiesanddevelopcurriculumfor2017andbeyond.AnenhancedwebpagecontainingalloftheworkfromthisareawillbepostedontheVHCIPwebsiteinearly2017.
Milestones:PerformancePeriod1:
1.Providequalityimprovementandcaretransformationsupporttoavarietyofstakeholders.2.Procurelearningcollaborativeandprovidertechnicalassistancecontractor.
PerformancePeriod1Carryover:Launch1cohortofLearningCollaborativesto3-6communities(communitiesdefinedbyVermont'sHealthServiceAreas)by1/15/15:
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1.Convenecommunitiesin-personandviawebinaralternatingformateachmonthfor12months.2.AssessimpactofLearningCollaborativemonthly.3.ProposeexpansionofLearningCollaborativeasappropriateby5/31/15.
PerformancePeriod2:OfferatleasttwocohortsofLearningCollaborativesto3-6communities:1.CreateexpansionplanforremainingVermontHSAsthatwanttoparticipateintheLearningCollaborativeprogramby6/15/15.2.ExpandexistingLearningCollaborativeprogramtoatleast6additionalhealthserviceareasby6/30/16.
PerformancePeriod3:1.Target:400VermontprovidershaveparticipatedinLearningCollaborativeactivities(includingIntegratedCommunitiesCareManagementLearningCollaborativeorCoreCompetencyTrainings)by12/31/16.(BaselineasofDecember2015:200)2.ReportonprogrameffectivenesstoSteeringCommitteeandCoreTeamby12/31/16.3.IncorporateLearningCollaborativelessonslearnedintoSustainabilityPlanby6/30/17.
Metrics:CORE_ParticipatingProvider_[VT]_[ACO]_CommercialCORE_ParticipatingProvider_[VT]_[ACO]_MedicaidCORE_ParticipatingProvider_[VT]_[ACO]_MedicareCORE_ProviderOrganizations_[VT]_[ACO]_CommercialCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicareCORE_ParticipatingProviders_[VT]_[EOC]CORE_ProviderOrganizations_[VT]_[EOC]CORE_ParticipatingProviders_[VT]_[APMH]CORE_ProviderOrganizations_[VT]_[APMH]AdditionalGoals: #LivesImpacted:311asofDecember2016 #ParticipatingProviders:Approximately200(70-80percohort)KeyDocuments:• LearningCollaborativeWebpage• IntegratedCommunitiesCareManagementLearningCollaborativeToolkit
StateofVermontLead(s):PatJones,ErinFlynnContractorsSupporting:NancyAbernathey;BailitHealthPurchasing;DeborahLisi-Baker;PacificHealthPolicyGroup;VermontProgramforQualityHealthCare.ApparentAwardeesforCoreCompetencyTraining:VermontDevelopmentalDisabilitiesCouncil;PrimaryCareDevelopmentCorporation.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Noneatthistime.
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FocusArea:PracticeTransformationProject:CoreCompetencyTrainings(ProjectComplete)
ProjectSummary:TheCoreCompetencyTraininginitiativeofferedacomprehensivetrainingcurriculumtofrontlinestaffprovidingcarecoordination(includingcasemanagers,carecoordinators,etc.)fromawiderangeofmedical,social,andcommunityserviceorganizationsincommunitiesstatewide.Thecurriculumcoverscompetenciesrelatedtocarecoordinationanddisabilityawareness,andwillreinforceandexpanduponthedisabilityawarenessbriefsandtheIntegratedCommunitiesCareManagementLearningCollaborativecurriculum.Carecoordinationandcaremanagementcorecompetencytrainingincludedtopicssuchas:motivationalinterviewing,healthcoaching,healthliteracy,bias,cultureandvalues,communicationskills,transitionsincare,domesticandsexualviolence,workingwithcomplexcases,andprinciplesofteam-basedcare.TrainingfocusedoncorecompetenciesrelatedtoworkingwithindividualswithDLTSSneedsincludingtopicslikedisabilityandwellness,person-centeredcare,universaldesign/accessibility,facilitatinginclusivemeetingsandtrainings,culturalcompetence,transitionfrompediatrictoadultcare,sexualityandreproductivehealth,andtrauma-informedcare.Additionaltrainingopportunitiesincludedadvancedcarecoordinationtrainingforindividualsfacingchallengeswithmentalhealth,substanceuse,orhomelessness,carecoordinationtrainingformanagersandsupervisors,and“trainthetrainer”training.Intotal,36separatetrainingopportunitiesweremadeavailabletoupto240participantsstate-wide.Inordertoensuresustainabilityoftrainingmaterialsbeyondtheinitialtrainingperiod,trainingsessionswerefilmedandallmaterialsareavailableinanonlineformat.ThisprojectisanoffshootoftheIntegratedCommunitiesCareManagementLearningCollaborative,anditiscompleteasofDecember2016;theprojecttransitionedtothelocalcommunitieswithsupportfromtheBlueprintforHealthandVCOasofJanuary2017.ProjectTimelineandKeyFacts:• March2016–Day1ofsix-daycoretrainingseries.• April2016–Day2ofsix-daycoretrainingseries.• May2016–Day3ofsix-daycoretrainingseries.• June2016–Day4ofsix-daycoretrainingseries;Webinar1.• July2016–Day5ofsix-daycoretrainingseries;webinar2.• August2016–BurlingtonSection2training,Webinars3&4.• September2016–Day6ofsix-daycoretrainingseries;AdvancedCareCoordinationTrainingWorkshop.• October2016–CareCoordinationforManagersandSupervisors;Webinar5.• November2016–Train-the-TrainerTraining;Webinar6.• December2016–Webinar7.
StatusUpdate/ProgressTowardMilestonesandGoals:• Afteracompetitivebidreviewprocess,twotrainingorganizationswereselectedandcontractsexecuted.
BetweenJanuaryandMarch2016,Vermontengagedinpre-planningwithtrainers,curriculumfinalization,andplanningfortraininglogisticsinpreparationfortheinitialMarchevents.
• BetweenMarchandSeptember2016,monthlytrainingsofthesix-daycoretrainingserieswereheld.Day6ofthesix-daycoretrainingserieswasheldinthreelocations(North,Central,South)inSeptemberwithafocusonthetransitionfrompediatrictoadultcare,traumainformedcareandAdverseChildhoodEvents(ACEs).AnadditionalsectionoftrainingfortheBurlingtontrainingsitewasheldonthreeconsecutivedaysinAugust.
• Atwo-dayAdvanceCareCoordinationWorkshopwasheldinSeptember2016withafocusonskills,tools,andstrategieswithworkingwithcomplexcasesinvolvingmentalhealthdisorders,substanceuse,orhomelessness.Planningiscurrentlyunderwayforaone-dayworkshopformanagersandsupervisorstoofferskills,tools,andstrategiesforsupportingcarecoordinationanddisabilityawarenessskillsinorganizationsandstaffmembers.
• Aone-dayTrainingforManagersandSupervisorswasheldinOctober2016withafocusonhowtoprovideeffectivemanagementandleadership.Specifictopicsincludeddifferentcaremanagementcaredeliverymodels,teambasedcaredeliveryincludinginter-disciplinarycaseconferencemeetings,workingcollaborativelywithphysicians,andprovidinghighqualitysupervisiontopreventstaffburnout.
• Approximately240participantsfromapproximately90differentorganizationsacrossthestateparticipated.• WebinarsbetweenJulyandDecemberfocusedon:sexualityandreproductivehealthofpeoplewithdisabilities;
strategiesforworkingwithcomplexindividuals;facilitatinginclusivemeetingsandtrainings;deliveringculturallysensitivecaretoLGBTQVermonters;andontrauma-informedcare.
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• Allparticipant-facingmaterialsfromthesix-daycoretrainingseriesareavailableontheVHCIPwebsiteaspartofthenewpracticetransformation/learningcollaborative/trainingwebpage.
Milestones:ThisworkispartoftheLearningCollaborativesworkstream.PerformancePeriod1:
1.Providequalityimprovementandcaretransformationsupporttoavarietyofstakeholders.2.Procurelearningcollaborativeandprovidertechnicalassistancecontractor.
PerformancePeriod1Carryover:Launch1cohortofLearningCollaborativesto3-6communities(communitiesdefinedbyVermont'sHealthServiceAreas)by1/15/15:
1.Convenecommunitiesin-personandviawebinaralternatingformateachmonthfor12months.2.AssessimpactofLearningCollaborativemonthly.3.ProposeexpansionofLearningCollaborativeasappropriateby5/31/15.
PerformancePeriod2:OfferatleasttwocohortsofLearningCollaborativesto3-6communities:1.CreateexpansionplanforremainingVermontHSAsthatwanttoparticipateintheLearningCollaborativeprogramby6/15/15.2.ExpandexistingLearningCollaborativeprogramtoatleast6additionalhealthserviceareasby6/30/16.
PerformancePeriod3:1.Target:400VermontprovidershaveparticipatedinLearningCollaborativeactivities(includingIntegratedCommunitiesCareManagementLearningCollaborativeorCoreCompetencyTrainings)by12/31/16.(BaselineasofDecember2015:200)2.ReportonprogrameffectivenesstoSteeringCommitteeandCoreTeamby12/31/16.3.IncorporateLearningCollaborativelessonslearnedintoSustainabilityPlanby6/30/17.
Metrics:CORE_ParticipatingProvider_[VT]_[ACO]_CommercialCORE_ParticipatingProvider_[VT]_[ACO]_MedicaidCORE_ParticipatingProvider_[VT]_[ACO]_MedicareCORE_ProviderOrganizations_[VT]_[ACO]_CommercialCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicareCORE_ParticipatingProviders_[VT]_[EOC]CORE_ProviderOrganizations_[VT]_[EOC]CORE_ParticipatingProviders_[VT]_[APMH]CORE_ProviderOrganizations_[VT]_[APMH]AdditionalGoals:#ParticipatingProviders:240KeyDocuments:• CoreCompetencyTrainingMaterials
StateofVermontLead(s):ErinFlynn,PatJonesContractorsSupporting:VermontDevelopmentalDisabilitiesCouncil,PrimaryCareDevelopmentCorporation.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Noneatthistime.
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FocusArea:PracticeTransformationProject:Sub-GrantProgram–Sub-Grants(ProjectComplete)
ProjectSummary:TheVHCIPProviderSub-GrantProgramwaslaunchedin2014andprovided14awardsto12providerandcommunity-basedorganizationswhoareengagedinpaymentanddeliverysystemtransformation.Awardsrangefromsmallgrantstosupportemployer-basedwellnessprograms,tolargergrantsthatsupportstate-wideclinicaldatacollectionandimprovementprograms.Theoverallinvestmentinthisprogramisnearly$5million.ProjectTimelineandKeyFacts:• April2014–Firstroundofawardsmadetosub-grantees.• October2014–Secondroundofawardsmadetosub-grantees.• January2015-December2016–Continuedimplementation.Quarterlyprogressreportsincludesuccessesand
challenges,progresstowardprojectgoalsandevaluationupdates.• May2015–Firstsub-granteesymposiumheld.• October2015–Secondsub-granteesymposiumheld.• June2016–Thirdsub-granteesymposiumheld.• December2016–Sub-GrantProgramconcludes.
StatusUpdate/ProgressTowardMilestonesandGoals:• Allofthesub-grantprojectsconcluded;finalreportsareavailablehere.• Sub-granteessubmittedQ42016QuarterlyReportsduringthemonthofDecember,availablehere.• Projectstaffengagedtheevaluationteamandtheself-evaluationcontractortodeveloparobustplanforthe
disseminationoflessonslearned.Milestones:PerformancePeriod1:Developtechnicalassistanceprogramforprovidersimplementingpaymentreforms.PerformancePeriod1Carryover:Continuesub-grantprogram:
1.Convenesub-granteesatleastonceby6/30/15.2.Eachquarter,analyzereportsfiledbysub-granteesusinglessonsfromsub-granteestoinformprojectdecision-making.
PerformancePeriod2:Continuesub-grantprogram:1.Convenesub-granteesatleastonceby6/30/16.2.Eachquarter,analyzereportsfiledbysub-granteesusinglessonsfromsub-granteestoinformprojectdecision-making.
PerformancePeriod3:1.ProvideSIMfundstosupportsub-granteesthrough12/31/16.2.Convenesub-granteesatleasttwiceby12/31/16.3.Eachquarter,analyzereportsfiledbysub-granteesusinglessonsfromsub-granteestoinformprojectdecision-making.4.Finalreportonthesub-grantprogramdevelopedbyVermont’sself-evaluationcontractorby6/30/17.
Metrics:CORE_ParticipatingProvider_[VT]_[ACO]_CommercialCORE_ParticipatingProvider_[VT]_[ACO]_MedicaidCORE_ParticipatingProvider_[VT]_[ACO]_MedicareCORE_ProviderOrganizations_[VT]_[ACO]_CommercialCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicareCORE_ParticipatingProviders_[VT]_[EOC]CORE_ProviderOrganizations_[VT]_[EOC]CORE_ParticipatingProviders_[VT]_[APMH]CORE_ProviderOrganizations_[VT]_[APMH]AdditionalGoals: #LivesImpacted:339,648 #ParticipatingProviders:14,078KeyDocuments:• Q42016Sub-GrantProgramProjectQuarterlyReports
March2017 27
• Sub-GrantProgramWebsite• DescriptionsofAllSub-GrantProjects
StateofVermontLead(s):GeorgiaMaherasContractorsSupporting:12sub-grantees;UniversityofMassachusetts.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Thisprojectiscomplete.
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FocusArea:PracticeTransformationProject:Sub-GrantProgram–TechnicalAssistance(ProjectComplete)
ProjectSummary:TheSub-GrantTechnicalAssistanceprogramwasdesignedtosupporttheawardeesofprovidersub-grantsinachievingtheirprojectgoals.VHCIPrecognizedthatwhiletheprovidersub-granteesarefocusedoncreatinginnovativeprogramstotransformtheirpracticesandtestmodelsofuniquecaredelivery,theyrequiresupporttodevelopthenecessaryinfrastructure.TheVHCIPinitiallycontractedwithfivecontractorstoprovidethissupport;contractsremaininplacewiththreeTAproviders,listedbelowProjectTimelineandKeyFacts:• December2014–Fivecontractsawardedtothecontractorslistedbelowinordertoensuretechnicalassistance
isavailabletothesub-granteesinavarietyofareas.• January2015-December2016–Threecontractorsprovideongoingtechnicalsupportfordataanalytics,policy
development,paymentmodelandcaremodeldesign,qualitymeasurementidentification,financialanalysisandactuarialservices.
StatusUpdate/ProgressTowardMilestonesandGoals:• TheSub-GrantProgramhasconcluded.Sub-granteetechnicalassistancecontractorswereavailableasrequested
bysub-granteesandapprovedbyprojectleadershipthroughthelifeoftheSub-GrantProgram.Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:Providetechnicalassistancetosub-granteesasrequestedbysub-grantees:
1.Remindsub-granteesofavailabilityoftechnicalassistanceonamonthlybasis.2.Ensuretechnicalassistancecontractshavesufficientresourcestomeetneedsofsub-grantees.
PerformancePeriod2:Providetechnicalassistancetosub-granteesasrequestedbysub-grantees:1.Remindsub-granteesofavailabilityoftechnicalassistanceonamonthlybasis.2.Ensuretechnicalassistancecontractshavesufficientresourcestomeetneedsofsub-grantees.
PerformancePeriod3:Providetechnicalassistancetosub-granteesasrequestedbysub-granteesthrough12/31/16:1.Remindsub-granteesofavailabilityoftechnicalassistanceonamonthlybasis.2.Ensuretechnicalassistancecontractshavesufficientresourcestomeetneedsofsub-grantees.3.Finalreportonthesub-grantprogramdevelopedbyVermont’sself-evaluationcontractorby6/30/17.
Metrics:CORE_ParticipatingProvider_[VT]_[ACO]_CommercialCORE_ParticipatingProvider_[VT]_[ACO]_MedicaidCORE_ParticipatingProvider_[VT]_[ACO]_MedicareCORE_ProviderOrganizations_[VT]_[ACO]_CommercialCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicareCORE_ParticipatingProviders_[VT]_[EOC]CORE_ProviderOrganizations_[VT]_[EOC]CORE_ParticipatingProviders_[VT]_[APMH]CORE_ProviderOrganizations_[VT]_[APMH]AdditionalGoals: #LivesImpacted:339,648 #ParticipatingProviders:14,078KeyDocuments:SeeVHCIPContractspageforTAcontracts,notedbelow.StateofVermontLead(s):GeorgiaMaherasContractorsSupporting:BailitHealthPurchasing;PolicyIntegrity;WakelyActuarial.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Thisprojectiscomplete.
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FocusArea:PracticeTransformationProject:RegionalCollaborations
ProjectSummary:WithineachofVermont’s14HealthServiceAreas(HSAs),BlueprintforHealthandACOleadershiphavemergedtheirworkgroups,collaboratingwithstakeholders.TheseRegionalCollaborations,alsoknownasCommunityCollaboratives,includemedicalandnon-medicalproviders(e.g.,long-termservicesandsupportsprovidersandcommunityproviders),andasharedgovernancestructurewithlocalleadership.Thesegroupsfocusonreviewingandimprovingtheresultsofkeymeasuresandpopulationhealthindicators,supportingtheintroductionandextensionofnewservicemodels,providingguidanceformedicalhomeandcommunityhealthteamoperations,andcommunitypriority-setting.WhiletheCommunityCollaborativesarerolledoutonastatewidelevel,eachregionhasenoughlocalcontroltocollaborativelydevelopacharter,membership,andculturethatworksbestfortheircommunities.CommunityCollaborativesbuilduponexistinginfrastructure,whileavoidingduplication.ProjectTimelineandKeyFacts:• November2014–VermontACOandBlueprintleadershipbeganmeeting.• October2014-August2015–Expandedexistingcommunityteamsbeganworkingwithleadershiptorealign
existingteams,putgovernancedocumentationinplace,andre-evaluateandsetnewcommunitypriorities.• March2015–ReleasedplansandimplementationdocumentsforRegionalCollaboratives.• June2015–LaunchedBasecampasanopportunitytosharelearningsandcollaborateintwopilotcommunities.• August2015–12of14communitieshadaCharterinplaceandcommunityfocusareasdefined;8additional
communitiesjoinedtheIntegratedCommunitiesCareManagementLearningCollaborative.• March2016–13of14communitieshadacharterinplace;14of14haddefinedoneormorefocusareas.• November2016–All14communitieshaveacharterinplaceandareidentifyingandinitiatingquality
improvementworkbasedonidentifiedpriorities.Manycommunitiesarebeginningtoanalyzeandunderstandtheresultsoftheirinterventions.Examplesofkeyfocusareasinclude:theIntegratedCommunitiesCareManagementLearningCollaborativeandtheAccountableCommunitiesforHealthPeerLearningLab,transitionalcare,combatingopiateaddiction,EDutilization,30daysallcausereadmissions,CHF,COPD,SBIRT,hospiceandpalliativecareutilization,obesity,adolescentwellvisits,developmentalscreenings,oralhealth,unplannedpregnancies,chronicpainanddepression.PromisingdatahasemergedinlongstandingprojectssuchasCHFreductionanddevelopmentalscreeningrates,andexistingprojectssuchasdecreasingEDutilizationcontinuetochallengecommunities.
• February2017–AsselectcommunitiesacrossthestatebeganparticipationintheVermontNextGenerationMedicaidACOprogram,theimplementationoftheVMNGpaymentandcaremodels(includingthecarecoordinationmodel)aretopicsofexplorationforcommunitiesstatewide.Manycommunitiesareseekingtolearnmoreabouttheprograminanticipationofjoiningoneormorepayerprogramsin2018.
• SeveralcommunitiescontinuetoexploretheopportunityofleveragingregionalcollaborationstoimplementanAccountableCommunitiesforHealthmodel.KeystateandACOleadershipwillcontinuetomeettoexplorewaystheycanbestsupportcommunitiesinthiswork.(SeeAccountableCommunitiesforHealthStatusReport)
StatusUpdate/ProgressTowardMilestonesandGoals:• RegionalCollaborationsbegunineachoftheState’s14HealthServiceAreas.• WeeklystakeholdermeetingstodiscussfurtherdevelopmentanddirectionoftheseRegionalCollaborations.• RegularpresentationstoVHCIPworkgroupsonprogressineachregionhighlightingspecificcasestudiesfrom
communitiesseeingpositiveearlyresults.• Communitiesareestablishingasharedcommunity-widegovernancestructureandinworkingtogethertodefine
theneeds,priorities,andoverarchingvisionfortheircommunity.• Collaborativeteamsareworkingtoaddengagedconsumerrepresentation.• TeamshaveestablishedprotocolsfortheregularsharingofdataprofilesfromsourcessuchasACOsandthe
BlueprintforHealthinordertoensurethatallqualityimprovementeffortsaredata-drivenandevidence-based.• Stateleadershipwillcontinuetosupportlocalleadershipteamsastheycontinuetomatureinstructureand
decision-makingprocesstoensurereadinessforupcomingreforms.• Worktosetcommonpopulationhealthindicators,measures,targets,anddriversremainsakeyfocusof
RegionalCollaborationleadership.Milestones:PerformancePeriod1:N/A
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PerformancePeriod1Carryover:EstablishregionalcollaborationsinhealthservicesareasbybeginningtodevelopaCharter,governingbody,anddecision-makingprocess:
1.DevelopCharter,decision-makingprocess,andparticipantsfor6HSAsby11/30/15.2.RequiremonthlyupdatesfromACOs/BlueprintforHealth.
PerformancePeriod2:Expansionofregionalcollaborationstoall14HealthServiceAreas(HSAs)by6/30/16.ExpansioniscompletewhenallHSAshaveaCharter,governingbody,anddecision-makingprocess.PerformancePeriod3:
1.Supportregionalcollaborationsin14HSAsbyprovidingsub-grantstoACOsandothertechnicalassistanceresources.2.Developatransitionplanby4/30/17toshiftallHSAstonon-SIMresources.3.IncorporateintoSustainabilityPlanby6/30/17.
Metrics:CORE_ParticipatingProvider_[VT]_[ACO]_CommercialCORE_ParticipatingProvider_[VT]_[ACO]_MedicaidCORE_ParticipatingProvider_[VT]_[ACO]_MedicareCORE_ProviderOrganizations_[VT]_[ACO]_CommercialCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicareCORE_ParticipatingProviders_[VT]_[EOC]CORE_ProviderOrganizations_[VT]_[EOC]CORE_ParticipatingProviders_[VT]_[APMH]CORE_ProviderOrganizations_[VT]_[APMH]AdditionalGoals: #LivesImpacted:TBD #ParticipatingProviders:TBDKeyDocuments:StateofVermontLead(s):JenneySamuelsonContractorsSupporting:Bi-StatePrimaryCareAssociation/CommunityHealthAccountableCare;PacificHealthPolicyGroup;UVMMedicalCenter/OneCareVermont.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:• Despiteprogressmadetodate,moreworkisneededtoformalizetheauthorityoftheRegionalCollaboration
leadershipteamsinordertodriveprioritysettinganddecisionmakingatalocalandregionallevel.TheBlueprintforHealthandVCOcontinuetocollaboratetooffersupporttoRegionalCollaborationsastheyworktoachievethisgoal.
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FocusArea:PracticeTransformationProject:Workforce–CareManagementInventory(ProjectComplete)
ProjectSummary:In2014,theCareModelsandCareManagement(CMCM)WorkGroupdesignedandfieldedasurveytovariousorganizationsengagedincaremanagement,toprovideinsightintothecurrentlandscapeofcaremanagementactivitiesinVermont.Thesurveyaimedtobetterunderstandstaffinglevelsandtypesofpersonnelengagedincaremanagement,aswellasthepopulationsbeingserved.TheprojectwascompletedinFebruary2016.ProjectTimelineandKeyFacts:• June2014–CMCMWorkGroupdesignedandfieldedcaremanagementinventorysurvey.• February2015–ResultsofsurveypresentedtoCMCMWorkGroup.• February2016–ResultsofsurveytobepresentedtoWorkforceWorkGrouptosupportfuturediscussionsof
caremanagementworkforcesupplyanddemandtrends.StatusUpdate/ProgressTowardMilestonesandGoals:• CareManagementInventorySurveywasadministeredin2014.• ResultswerepresentedtotheCareModels&CareManagementWorkGroupinFebruary2015.• ResultswerepresentedtotheWorkforceWorkGroupinFebruary2016.
Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:Obtainsnapshotofcurrentcaremanagementactivities,staffing,peopleserved,andchallenges:
1.ObtainDraftReportby3/31/15.2.Presentto2workgroupsby5/31/15.3.FinalReportdueby9/30/15.
PerformancePeriod2:N/APerformancePeriod3:N/AMetrics:CORE_ParticipatingProvider_[VT]_[ACO]_CommercialCORE_ParticipatingProvider_[VT]_[ACO]_MedicaidCORE_ParticipatingProvider_[VT]_[ACO]_MedicareCORE_ProviderOrganizations_[VT]_[ACO]_CommercialCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicareCORE_ParticipatingProviders_[VT]_[EOC]CORE_ProviderOrganizations_[VT]_[EOC]CORE_ParticipatingProviders_[VT]_[APMH]CORE_ProviderOrganizations_[VT]_[APMH]AdditionalGoals: #LivesImpacted:N/A #ParticipatingProviders:N/AKeyDocuments:• CareManagementSurveyReport
StateofVermontLead(s):ErinFlynnContractorsSupporting:BailitHealthPurchasing.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Thisprojectiscomplete.
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FocusArea:PracticeTransformationProject:Workforce–DemandDataCollectionandAnalysis
ProjectSummary:A“micro-simulation”demandmodelwilluseVermont-specificdatatoidentifyfutureworkforceneedsfortheStatebyinputtingvariousassumptionsaboutcaredeliveryinahigh-performinghealthcaresystem.TheselectedvendorforthisworkiscreatingademandmodelthatidentifiesidealworkforceneedsforVermontinthefuture,undervariousscenariosandparameters.ProjectTimelineandKeyFacts:• June2014–WorkforceWorkGroupbegandiscussingdemandmodelingtoprojectfuturehealthcaredemands.• Spring2016–RFPreleasedinJanuary2016.AOAexecutedacontractwiththeselectedvendorinMayand
providedpreliminarydataforvendortobeginpopulationprojectionsandmodeladjustment.• November2016–Vendorpreparedandsubmittedadraftreportofdemandprojections,withinputfrom
VermontstakeholdersincludingtheWorkforceWorkGroup,andrefinemodelandreportbasedonfeedback.• January2017-March2017–Vendorupdateddemandprojectionswithnewdatasets.
StatusUpdate/ProgressTowardMilestonesandGoals:• VermontstakeholdersbeganholdingmonthlymeetingswithIHSinJune2016andcontinuetoprovide
quantitativeandqualitativedatatovendorforfurthermodelrefinement.• IHSranpreliminaryprojectionsforRNs,MDs,APRNs,andPAsbysubspecialtiesandHSAsinJune-July2016.• IHSandVermont,withinputfromkeystakeholdersfromthepublicandprivatesectors,draftedaprioritizedlist
ofdemandmodelingscenariostoberunthroughthemodelinlatesummer.• IHSpresentedadraftreportofdemandprojectionsandmodelingscenariostoVermontstakeholdersatthe
DecemberWorkforceWorkGroupmeetingandwillincorporatefeedbackintomodelrefinements.• IHScontinuestorefineitsmodelusingtheVHCURESdataset,tomoreaccuratelyreflecttheVermontpopulation.• IHScontinuestoincorporateadditionaldemandscenariosintoitsmodelandreports.
Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:N/APerformancePeriod2:
1.Executecontractformicro-simulationdemandmodelingby1/15/16(dependentonfederalapproval).2.Providepreliminarydataasdefinedbythecontracttovendorforuseinmodelby3/15/16.
PerformancePeriod3:SubmitFinalDemandProjectionsReportandpresentfindingstoWorkforceWorkGroupby12/31/16.Metrics:CORE_ParticipatingProvider_[VT]_[ACO]_CommercialCORE_ParticipatingProvider_[VT]_[ACO]_MedicaidCORE_ParticipatingProvider_[VT]_[ACO]_MedicareCORE_ProviderOrganizations_[VT]_[ACO]_CommercialCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicareCORE_ParticipatingProviders_[VT]_[EOC]CORE_ProviderOrganizations_[VT]_[EOC]CORE_ParticipatingProviders_[VT]_[APMH]CORE_ProviderOrganizations_[VT]_[APMH]AdditionalGoals: #LivesImpacted:N/A #ParticipatingProviders:N/AKeyDocuments:• HealthCareWorkforceWorkGroupWebpage
StateofVermontLead(s):AmyCoonradt(MatBarewicz)ContractorsSupporting:IHSGlobal.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:• Ano-costextensionthroughJune2017willaccommodatedelaysinvendoraccesstoVHCURESdata.
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FocusArea:PracticeTransformationProject:Workforce–SupplyDataCollectionandAnalysis
ProjectSummary:TheOfficeofProfessionalRegulationandVermontDepartmentofHealth(VDH)workintandemtoassesscurrentandfuturesupplyofprovidersinthestate’shealthcareworkforceforhealthcareworkforceplanningpurposes,throughcollectionoflicensureandrelicensuredataandtheadministrationofsurveystoprovidersduringthelicensure/relicensureprocess.Surveysincludekeydemographicinformationforproviders,andareusedforworkforcesupplyassessmentandpredictingsupplytrends,aswellasinformingfutureiterationsofVermont’sHealthCareWorkforceStrategicPlan.ProjectTimelineandKeyFacts:• January2015–AdditionalFTEhiredatVDHtoassistwithsurveydevelopment/administrationanddataanalysis.• April2015–HealthCareWorkforceWorkGroupprovidedinputtoVDHregardingreportcontentandformatting.• October2015–HealthCareWorkforceWorkGroupreceivedstatusupdateondatacollection,progress,and
scheduleofsurveyadministrationbyprovidertype.• February2016–VDHproposedformingasub-groupoftheHealthCareWorkforceWorkGroupandotherkey
subjectmatterexperts.ThesubgroupanalyzedVDHdataandprovidedthisanalysistothebroaderworkgroup,withthegoalofinformingworkgroupactivities.
• June-October2016–VDHandothersubjectmatterexpertswithinWorkGroupconducted“deeperdive”analysisofdataonphysicianassistantsanddiscussedwaysofutilizingPAstoincreaseaccesstoprimarycareinVermont.Thisdiscussionwillcontinueatsubsequentmeetingsandwillincludeanalysisofotherprimarycareprofessions,inordertofurtheremphasizeteam-basedprimarycareintheVermontworkforce.VDHandothersubjectmatterexpertsalsoconductedsecond“deeperdive”analysisofdata,focusingonmentalhealthandsubstanceabuseprofessionsinVermont.Thisdiscussionwillcontinueatsubsequentmeetings.
StatusUpdate/ProgressTowardMilestonesandGoals:• TheVermontDepartmentofHealthhiredadditionalstafftodevelopandadministersurveystoaccompany
providerre-licensureapplications,andperformanalysisonlicensuredataanddevelopproviderreportsonvarioushealthcareprofessions.
• VDHstaffreportanalyticfindingstotheworkgrouponanongoingbasis.Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:Usesupplydata(licensureandrecruitment)toinformworkforceplanningandupdatestoWorkforceStrategicPlan.PerformancePeriod2:Continuetousesupplydata(licensureandrecruitment)toinformworkforceplanningandupdatestoWorkforceStrategicPlan:
1.PresentdatatoWorkforceWorkGroupatleast4timesbetween1/1/15and6/30/16.2.Publishdatareports/analysesonwebsiteby12/31/15.3.Distributereports/analysestoprojectstakeholdersby12/31/15.
PerformancePeriod3:Usesupplydata(licensureandrecruitment)toinformworkforceplanningandupdatestoWorkforceStrategicPlan:
1.PresentdatatoWorkforceWorkGroupatleast3timesby12/31/16.2.Publishdatareports/analysesonwebsiteby6/30/17.3.Distributereports/analysestoprojectstakeholdersby6/30/17.4.IncorporateintoSustainabilityPlanby6/30/17.
Metrics:CORE_ParticipatingProvider_[VT]_[ACO]_CommercialCORE_ParticipatingProvider_[VT]_[ACO]_MedicaidCORE_ParticipatingProvider_[VT]_[ACO]_MedicareCORE_ProviderOrganizations_[VT]_[ACO]_CommercialCORE_ProviderOrganizations_[VT]_[ACO]_MedicaidCORE_ProviderOrganizations_[VT]_[ACO]_MedicareCORE_ParticipatingProviders_[VT]_[EOC]CORE_ProviderOrganizations_[VT]_[EOC]CORE_ParticipatingProviders_[VT]_[APMH]
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CORE_ProviderOrganizations_[VT]_[APMH]AdditionalGoals: #LivesImpacted:N/A #ParticipatingProviders:N/AKeyDocuments:StateofVermontLead(s):AmyCoonradtContractorsSupporting:N/AAnticipatedRisksandMitigationStrategy:Noneatthistime.
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FocusArea:HealthDataInfrastructure
FocusArea:HealthDataInfrastructureProject:ExpandConnectivitytoHIE–GapAnalyses(ProjectComplete)
ProjectSummary:TheGapAnalysisisanevaluationoftheElectronicHealthRecord(EHR)systemcapabilityofhealthcareorganizations,interfaceabilityoftheEHRsystem,andthedatatransmittedwithinthoseinterfaces.ConductingtheACOGapAnalysiscreatedabaselinedeterminationoftheabilityofhealthcareorganizationstoproduceYear1Medicare,Medicaid,andcommercialSharedSavingsACOProgramqualitymeasuredata.TheVermontCarePartners(VCP)GapAnalysisevaluateddataqualityamongthe16DesignatedandSpecializedServiceAgencies.Finally,theDLTSSGapAnalysiswasconductedtoreviewthetechnicalcapabilityofDLTSSprovidersstatewide.ThisworkstreamiscompleteasofDecember2015.ProjectTimelineandKeyFacts:• January2014–VITLandACOteamslaunchedGapAnalysisoftheACOProgramqualitymeasures.• July2014–GapAnalysisoftheACOProgramqualitymeasuredatacompleted.• September2014–DLTSSInformationTechnologyAssessmentworklaunched.• January2015–ScopeofWorkforVCPGapAnalysisfinalized.• February2015–WorkbeganforVCPGapAnalysiswithintroductorymeetingwithDesignatedAgencies.• February2015–DraftDLTSSInformationTechnologyAssessmentReportcompleted.• July2015–Atotalof67dataqualitymeetingsheldwithDAs&SSAs.• November2015–DLTSSInformationTechnologyAssessmentReportcompleted.• December2015–DLTSSInformationTechnologyAssessmentfindingspresentedtoHDIWorkGroup.
StatusUpdate/ProgressTowardMilestonesandGoals:• GapAnalysisofACOProgramdataqualitymeasurescompletedinJanuary2014.• VITLconductednumerousdataqualityinterviewswiththe16DesignatedMentalHealthandSpecializedService
agencies(DAsandSSAs).VITLalsoidentifiedthatanumberofDAandSSAmemberagencies’structuresaredecentralizedsuchthattheyoperateasmultipleindependentagencies.VCPconfirmedtheneedforfullassessmentstobeconductedattheseagencies.
• DLTSSInformationTechnologyAssessmentReportcompletedwithrecommendationsonnextsteps;reportwasdistributedtostakeholdersandfindingspresentedtotheHDIWorkGroup.
Milestones:PerformancePeriod1:Performgapanalysesrelatedtoqualitymeasuresforeachpaymentprogram,asappropriate;performbaselinegapanalysestounderstandconnectivityofnon-MeaningfulUse(MU)providers.PerformancePeriod1Carryover:Performgapanalysesrelatedtoqualitymeasuresforeachpaymentprogram,asappropriate;performbaselinegapanalysestounderstandconnectivityofnon-MeaningfulUse(MU)providers:
1.CompleteDLTSStechnicalgapanalysisby9/30/15.2.ConductbimonthlySSPqualitymeasuregapanalysesforACOproviders.
PerformancePeriod2:N/APerformancePeriod3:N/AMetrics:CORE_HealthInfoExchange_[VT]AdditionalGoals: #LivesImpacted:TBD #ParticipatingProviders:400KeyDocuments:• ACOGapAnalysis(Fall2014)• DLTSSInformationTechnologyAssessmentReport(Fall2015)
StateofVermontLead(s):GeorgiaMaheras,LarrySandageContractorsSupporting:VITL;VermontCarePartners;H.I.S.Professionals;Bailit.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Thisprojectiscomplete.
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FocusArea:HealthDataInfrastructureProject:ExpandConnectivitytoHIE–GapRemediation
ProjectSummary:TheGapRemediationprojectaddressesgapsinconnectivityandclinicaldataqualityofhealthcareorganizationstotheHealthInformationExchange.Gapremediationeffortsarefocusedinthreeareas:ACOmemberorganizations,Vermont’s16DesignatedMentalHealthandSpecializedServiceAgencies(DAsandSSAs),andHomeHealthAgencies.• TheACOGapRemediationcomponentimprovestheconnectivityforallVermontSharedSavingsProgram
measuresamongACOmemberorganizations.Theprojectincludesfivedeliverables:InterfaceandElectronicHealthRecordInstallation,DataAnalysis,DataFormatting,TerminologyServices,andSETTeamactivities.(ProjectComplete)
• TheVermontCarePartners(VCP)GapRemediationimprovedthedataqualityforVermont’sDAsandSSAs.(ProjectComplete)
• TheDLTSSGapRemediationeffortseekstoincreaseconnectivityandaccesstoclientinformationforHomeHealthAgencies.Thisproject,approvedinJanuary2016basedontheresultsoftheDLTSSInformationTechnologyAssessment,originallyincludedAreaAgenciesonAginginitsscope;AreaAgenciesonAgingarecurrentlyexcludedfromthisworkduetolegaldatasharingissues.
GapRemediationeffortsforACOmemberorganizationsandVCPdovetailwiththedataqualityimprovementeffortsdescribedunderthe“ImproveQualityofDataFlowingintoHIE”workstream.TheVCPDataQualityandTerminologyServicesprojectsarereportedunderthatfocusarea.ProjectTimelineandKeyFacts:• March2015–ACOGapRemediationworkbegunbyVITLandACOmemberorganizations;TerminologyServices
vendoridentifiedbyVITL.• May2015–SETTeamworkcompletedbyVITLandMedicity.• July2015–GapRemediationworkcontinued,with95ADT,VXU,andCCDinterfacesinprogress.• October2015–PhaseIIACOGapRemediationinitiallyproposed;VCPGapRemediationproposed.• January2016–PhaseIACOGapRemediationworkcompleted;VCPGapRemediationworkbegun;DLTSSGap
RemediationprojecttoincreaseconnectivityforHomeHealthAgenciesandAreaAgenciesonAgingapprovedandplanningprocessbegun.
• June2016–HomeHealthAgencyconnectivityprojectPhase1completed.• December2016–VCPGapRemediationworkcompleted.• June2017–HomeHealthAgencyconnectivityprojecttobecompleted.
StatusUpdate/ProgressTowardMilestonesandGoals:• InDecember2015,VITLincreasedthepercentageofOneCareVermontbeneficiariesabletoberepresentedin
QualityMeasurereportingto64%.• VITLandVCPproposedadditionalgapremediationworkinQuarter4of2015forPerformancePeriod3andthe
HDIWorkGroupapprovedproposalsforgapremediationfortheACOandVCPprojectsintheNovemberWorkGroupmeeting.
• TheHDIWorkGroupevaluatednextstepsbasedontheDLTSSInformationTechnologyAssessmentinNovember2015,andrecommendedpursuingconnectionsforHomeHealthAgenciesandAreaAgenciesonAging.ArevisedproposallimitedtoHomeHealthAgencieswasapprovedbytheCoreTeaminJanuary2016.HomeHealthAgencyinterfacediscoveryworkwascompletedasofJune2016.VITLAccessonboardingandinterfacedevelopmentworkisoccurringincollaborationwiththeHHAs,Statestaff,andVITL,andisscheduledforcompletioninJune2017.
• StateandVITLstaffcollaboratedonre-scopingtheHomeHealthAgencyinterfacework.ArequestwassubmittedtoextendtheworkuntilJune2017,reallocatingprojectfundinganddefiningthedeliverablesunderthisproject.
Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:N/APerformancePeriod2:Remediatedatagapsthatsupportpaymentmodelqualitymeasures,asidentifiedingapanalyses:
1.Remediate50%ofdatagapsforSSPqualitymeasuresby12/31/15.
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2.DeveloparemediationplanforgapsidentifiedinLTSStechnicalgapanalysisby12/31/15.PerformancePeriod3:
1.Remediate65%ofACOSSPmeasures-relatedgapsasidentifiedinFall2015/Spring2016by6/30/17.(BaselineasofDecember2015:62%)2.RemediatedatagapsforLTSSprovidersaccordingtoremediationplandevelopedinPerformancePeriod2by6/30/17.3.IncorporateGapRemediationactivitiesintoSustainabilityPlanby6/30/17.
Metrics:CORE_HealthInfoExchange_[VT]AdditionalGoals: #LivesImpacted:TBD #ParticipatingProviders:TBDKeyDocuments:StateofVermontLead(s):GeorgiaMaheras,LarrySandageContractorsSupporting:VITL;VermontCarePartners;H.I.S.Professionals;PacificHealthPolicyGroup.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Noneatthistime.
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FocusArea:HealthDataInfrastructureProject:ExpandConnectivitytoHIE–DataExtractsfromHIE(ProjectComplete)
ProjectSummary:ThisprojectprovidedasecuredataconnectionfromtheVHIEtotheACOsanalyticsvendorsfortheirattributedbeneficiaries,andallowedACOsdirectaccesstotimelydatafeedsforpopulationhealthanalytics.ThisworkstreamwascompletedasofJuly2016.ProjectTimelineandKeyFacts:• March2014–OneCare(OCV)Gatewaybuildstarted.• February2015–CommunityHealthAccountableCare(CHAC)Gatewaybuildstarted.• December2015–OCVandCHACGatewayscompleted.• January2016–ContractwithVITLtobuildHealthfirstGatewayapproved.• July2016–HealthfirstGatewaycompleted.
StatusUpdate/ProgressTowardMilestonesandGoals:• AllthreeGatewaysarecompleted.
Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:CompleteddevelopmentofACOGatewayswithOneCareVermont(OCV)by3/31/15andCommunityHealthAccountableCare(CHAC)by12/31/15tosupporttransmissionofdataextractsfromtheHIE.PerformancePeriod2:N/APerformancePeriod3:N/AMetrics:CORE_HealthInfoExchange_[VT]AdditionalGoals: #LivesImpacted:TBD #ParticipatingProviders:TBDKeyDocuments:StateofVermontLead(s):GeorgiaMaherasContractorsSupporting:VermontInformationTechnologyLeaders.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Thisprojectiscomplete.
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FocusArea:HealthDataInfrastructureProject:ImproveQualityofDataFlowingintoHIE(ProjectComplete)
ProjectSummary:TheDataQualityImprovementProjectinitiallyfocusedonanalyzingACOmembers’dataqualityinreferencetoeachofsixteendataelements.TheACODataQualityeffortswerelaterexpandedtoimproveworkflowanddataentryinmemberElectronicHealthRecordsystems,andtoincludeeffortstoimprovedataqualityandusabilityforDesignatedAgencies(DAs)andSpecializedServiceAgencies(SSAs).Toimprovedataquality,VITLworksdirectlywithproviderstorecommenddataentryanddatacaptureworkflowimprovements.VITLalsoperformscomprehensiveanalysestoensuredataelementsfromeachHealthCareOrganization(HCO)areformattedidentically,andworkswiththeHCOstoimprovequalityandusabilitythroughoneormoreofthefollowingmethods:(1)TheHCOcanchangetheirmethodofdataentry;(2)theHCO’svendorcanchangetheirformatusedtocapturedata;and(3)athirdpartycoulduseaterminologyservicetotransformthedata.TheTerminologyServicesproject,originallyinitiatedaspartoftheACOGapRemediationwork,examinedclinicaldataelementsandtranslatesthosedataelementsintostandardizedcodesets.ProjectTimelineandKeyFacts:• March2015–VITL-ACODataQualityworkbeganbydeployingVITL’seHealthSpecialistteamstomember
organizationsforreviewofDataQualityinputandworkflow.• July2015–Significantprogressmadeindataqualityassessmentandinitialphasesofgapremediationthrough
anexistingunderlyingcontractapprovedinPerformancePeriod1;additionalgapremediationprogressinPerformancePeriods2&3pendingFederalapprovalofcontractamendment.
• January2016–FundstosupportcontinuedworkontheVermontCarePartners(VCP)DataQualityprojectapprovedbytheVHCIPCoreTeam.
• February2016–TerminologyServicesworkbegun.• April2016–TerminologyServiceshardwareandsoftwareimplementationcomplete.• June2016–TerminologyServicesconfigurationandtrainingcompleted.• September2016–TerminologyServicessecondphaseapprovedbytheVHCIPCoreTeam.• December2016–VCPDataQualityworkcompleted.
StatusUpdate/ProgressTowardMilestonesandGoals:• Dataquantityandqualityimprovementsresultedinaddressing64%ofknowndatagapsforSSPquality
measures.• WorkwithVCP,DA/SSAmemberagencies,andVITLcontinuedthroughDecember2016.VITLworkedwithDAsto
implementtheworkflowimprovementsineachagencythroughthedevelopmentofatoolkitthatprovidesthenecessarydocumentation,workflows,andanswerstospecificquestionsasneeded.
• TheHDIWorkGroupapprovedadditionaldataqualityworkfortheACOandVCPprojectintheNovember2015WorkGroupmeeting.ThisrequestwasapprovedbytheSteeringCommitteeandCoreTeaminDecember2015andJanuary2016,respectively.
• VITLprovidedcontinuedDataQualityservicesfortheDesignatedMentalHealthAgencies(VCPDataQualityproject)throughworkflowsupporttoenableDAstafftoimproveinformationcollectionandstandardizeddataentryofrequireddataelements.Analysisofthedataidentifiedareasofimprovement,andthedatasetswereformattedtomeetstandarddataformatsfordevelopmentofconsistentandaccurateADTandCCDinterfaces.
• TerminologyServicesimplementationwillbesupportedatafuturedateunderanotherprogramin2017.Milestones:PerformancePeriod1:ClinicalData:
1.MedicationhistoryandproviderportaltoquerytheVHIEbyendof2013.2.StatelawrequiresstatewideavailabilityofBlueprintprogramanditsITinfrastructurebyOctober2013.
PerformancePeriod1Carryover:1.DataqualityinitiativeswiththeDAs/SSAs:ConductdataqualityimprovementmeetingswiththeDAs/SSAstofocusontheanalysisofthecurrentstateassessmentsforeachagency:atleast4meetingspermonthwithDA/SSAleadershipand6meetingspermonthwithindividualDAs/SSAstoreviewworkflow.2.Accesstomedicationhistorytosupportcare:150medicationqueriestotheVHIEbyVermontprovidersby12/31/15.
PerformancePeriod2:
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1.ImplementterminologyservicestooltonormalizedataelementswithintheVHIEbyTBD.2.EngageinworkflowimprovementactivitiesatproviderpracticestoimprovethequalityofthedataflowingintotheVHIEasidentifiedingapanalyses.Startworkflowimprovementactivitiesin30%ofACOattributingpracticesby6/30/16.
PerformancePeriod3:Engageinworkflowimprovementactivitiesatdesignatedmentalhealthagencies(DAs)asidentifiedingapanalyses.Startworkflowimprovementactivitiesinall16DAsby7/1/16andcompleteworkflowimprovementby12/31/16.Reportonimprovementoverbaselineby6/30/17.Metrics:CORE_HealthInfoExchange_[VT]AdditionalGoals: #LivesImpacted:TBD #ParticipatingProviders:977KeyDocuments:StateofVermontLead(s):GeorgiaMaheras,LarrySandageContractorsSupporting:BehavioralHealthNetwork/VermontCareNetwork;Bi-StatePrimaryCareAssociation/CommunityHealthAccountableCare;H.I.S.Professionals;UVMMedicalCenter/OneCareVermont;VermontInformationTechnologyLeaders.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Thisprojectiscomplete.
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FocusArea:HealthDataInfrastructureProject:Telehealth–StrategicPlan(ProjectComplete)
ProjectSummary:VermontcontractedwithJBSInternationaltodevelopaStatewideTelehealthStrategytoguidefutureinvestmentsinthisarea.TheStrategy,developedincollaborationwiththeStateofVermontandprivatesectorstakeholders,includesfourcoreelements:acoordinatingbodytosupporttelehealthactivities;alignmentofstatepoliciesrelevanttotelehealth;telehealthtechnologyinvestmentsthataresecure,accessible,interoperable,cloud-based,andalignedwithVermont’sHITinfrastructure;andclinicianengagement.TheStrategyalsoincludesaRoadmapbasedonVermont’stransitionfromvolume-basedtovalue-basedreimbursementmethodologiestoguideprioritizationoftelehealthprojectsandtheiralignmentwithnewclinicalprocessesadoptedaspaymentreformevolves.Thisprojectiscomplete.ProjectTimelineandKeyFacts:• February2015–Projectlaunched.• March-July2015–VermontTelehealthSteeringCommitteeconvenedinMarch2015toguideTelehealth
Strategydevelopment;theSteeringCommitteecontinuedtomeetthroughJuly.• June2015–ContractorpresenteddraftstrategyelementstotheHIE/HITWorkGroupforcomments.• August2015–FinalStrategyelementsapproved.• June-September2015–Strategyreviewandediting.• September2015–FinalStrategydocumentapprovedbyStateofVermont;finalStrategyreleased.Theprojectis
complete.StatusUpdate/ProgressTowardMilestonesandGoals:• JBSInternationalconvenedtheVermontTelehealthSteeringCommitteeinMarch2015toguideTelehealth
Strategydevelopment.SteeringCommitteemembersmetbiweeklyviaphonebetweenMarchandJulytocometoconsensusonatelehealthdefinition,identifyguidingprinciplesforthestrategy,reviewkeyfeaturesontelehealthprogramsacrossthecountry,anddevelopstrategyelements.
• AdraftStatewideTelehealthStrategywassubmittedtoDVHAinJune2015;JBSworkedwithSOVstafftorefinetheStrategybetweenJuneandSeptember2015.
• ThefinalstrategyelementswereapprovedbytheHIE/HITWorkGroup,SteeringCommittee,andCoreTeaminAugust2015.
• TheStateofVermontfinalizedtheStrategyinSeptember2015andreleasedthefinalStrategyinmid-September.Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:N/APerformancePeriod2:DevelopTelehealthStrategicPlanby9/15/15.PerformancePeriod3:N/AMetrics:CORE_HealthInfoExchange_[VT]AdditionalGoals: #LivesImpacted:N/A #ParticipatingProviders:N/AKeyDocuments:• AStatewideTelehealthStrategyfortheStateofVermont
Lead(s):SarahKinslerContractorsSupporting:JBSInternational.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Thisprojectiscomplete.
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FocusArea:HealthDataInfrastructureProject:Telehealth–Implementation
ProjectSummary:Vermontisfundingpilotprojectsthatcanaddressavarietyofgeographicalareas,telehealthapproachesandsettings,andpatientpopulations.Theprimarypurposeistoexplorewaysinwhichacoordinatedandefficienttelehealthsystemcansupportvalue-basedcarereimbursementthroughouttheStateofVermont.ProjectswereselectedinpartbasedondemonstrationofalignmentwithVermont’sSIMgoals.Projectsummaries:• TheVNAofChittendenandGrandIsleCountiesisdevelopingtelehealthinfrastructurebybuildingconnections
amongprovidersandenablingthetimelysharingofclinicalinformation.ThistelehealthpilotisenablingVNAandCentralVermontHomeHealth&Hospice(CVHHH)toconnecttheirpointofcaresystems(HoneywellLifestream)totheirEMRsystems(McKesson)sothatvitalstakenbyvisitingnursesareavailableintheEMR.Theseresults(inHL7’sORUformat)canalsobesentfromtheEMRintotheVermontHealthInformationExchange(VHIE);pointofcareinformationisnowsharedwithinthenursingorganizationaswellaswithanyprovideraccessingtheVHIEthroughtheVITLAccess.Thisenablesthehomehealthorganizationstobeintegralpartnerswithnumerousproviders,includingtheUniversityofVermontHealthNetwork,forthecareofpeoplewithawiderangeofchronicconditions.
• TheHowardCenter,amajormentalhealthandsubstanceusedisordertreatmentproviderinthestate,isusingtelehealthtechnologytoexpandaccesstomedication-assistedtreatment(MAT)forpeoplewithopioiddependence.TheHowardCenterisusinglivevideoandsecure,tamperproofmedicationdispenserstoallowqualifyingindividualstoreceiveMATintheirhomeswithstaffsupervision.
ProjectTimelineandKeyFacts:• August2015–ApprovalofdraftRFPscope.• September2015–RFPreleased.• November2015–Pilotprojectsselected.• AprilandJune2016-June2017–Pilotprojectperiods,includingwrap-up,evaluation,andreporting.
StatusUpdate/ProgressTowardMilestonesandGoals:• AnRFPscopewasdevelopedbytheStateandJBSInternational,drawingonthetelehealthdefinition,guiding
principles,andTelehealthStrategyelements.TheRFPwasreleasedinSeptember2015,andtwopilotswereselectedinNovember.ContractsexecutedfortwoawardeesinJuly2016.PilotsbeganinAprilandJune2016.
• AsofMarch2017,bothpilotprojectshavemadesignificantprogress,andcompletedtelehealthtechnologypurchasestosupporttheirwork.BothpilotcontractsareextendedthroughJune2017toallowadditionaltimeforpilotimplementation.
Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:N/APerformancePeriod2:
1.ReleasetelehealthprogramRFPby9/30/15.2.AwardatleastonecontracttoimplementthescopeofworkinthetelehealthprogramRFPby1/15/16.
PerformancePeriod3:1.Continuetelehealthpilotimplementationthroughcontractenddates.2.IncorporateTelehealthProgramintoSustainabilityPlanby6/30/17.
Metrics:CORE_HealthInfoExchange_[VT]AdditionalGoals: #LivesImpacted:TBD #ParticipatingProviders:TBDKeyDocuments:• AStatewideTelehealthStrategyfortheStateofVermont
Lead(s):JimWestrichContractorsSupporting:HowardCenter;VNAofChittendenandGrandIsleCounties.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:• Delaysinbidderselectionandcontractnegotiationsresultedindelayedprogramlaunch.
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o Condensedprojecttimelineslimittheimpactofthisdelay.Thetimelineabovereflectsdelays.
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FocusArea:HealthDataInfrastructureProject:EMRExpansion(ProjectComplete)
ProjectSummary:EMRExpansionfocusedonassistingintheprocurementofEMRsystemsfornon-MeaningfulUse(MU)providers,focusingonEMRacquisitionforfiveSpecializedServiceAgencies(SSAs)andDepartmentofMentalHealth/StatePsychiatricHospital.Thisprojectiscomplete.ProjectTimelineandKeyFacts:• January2015–EMRacquisitionprojectbeganwithseveralcontractors:VITL,VCP,andARISforfiveSpecialized
ServiceAgencies(SSAs).• January-June2015–VITLassistedVermont’sDepartmentofMentalHealthinprocuringnewEMRsolutionfor
StatePsychiatricHospital.• July2015–VendorselectedforSSAEMRacquisitionandcontractnegotiationscompleted.• August2015–ContractexecutedforSSAEMRacquisition.Theprojectiscomplete.• June2016–SSAEMRimplementationscomplete.
StatusUpdate/ProgressTowardMilestonesandGoals:• EMRacquisitionforfiveSpecializedServiceAgenciesiscomplete.• VITLprovidedtechnicalassistancetotheDepartmentofMentalHealthtosupportprocurementoftheEMR
systemfortheState’snewhospital.Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:N/APerformancePeriod2:
1.AssistinprocurementofEMRfornon-MUproviders:VermontStatePsychiatricHospital(by6/30/15)andARIS(DevelopmentalDisabilityAgencies)(by6/30/16).2.Explorenon-EMRsolutionsforproviderswithoutEMRs:developplanbasedonLTSStechnicalgapanalysis.
PerformancePeriod3:N/AMetrics:CORE_HealthInfoExchange_[VT]AdditionalGoals: #LivesImpacted:TBD #ParticipatingProviders:TBDKeyDocuments:StateofVermontLead(s):GeorgiaMaheras,LarrySandageContractorsSupporting:VITL,VermontCarePartners,ARIS.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Thisprojectiscomplete.
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FocusArea:HealthDataInfrastructureProject:DataWarehousing
ProjectSummary:TheDataWarehousingworkstreamincludesthreeindependentprojects:TheVermontCarePartners(VCP)DataRepositoryproject,theClinicalRegistryMigrationproject,andstatewideplanningtodevelopacohesivedatawarehousingstrategy.• TheVCNDataRepositoryallowstheDesignatedMentalHealthAgencies(DAs)andSpecializedServiceAgencies
(SSAs)tosendspecificdatatoacentralizeddatarepository.InadditiontoactingasacentralizedrepositoryforDA/SSAdata,itisexpectedthatthisprojectwillprovideVCPmemberswithadvanceddataanalyticcapabilitiestoimprovetheefficiencyandeffectivenessoftheirservices,todemonstratevalue,andtoparticipateinpaymentanddeliverysystemreforms.
• TheClinicalRegistryMigrationprojectmovedtheBlueprintforHealthClinicalRegistryfromitspreviousenvironmenttobehostedwithinVITL’sinfrastructure.(ProjectComplete)
• Statewideplanningactivitiesfocusondevelopingalong-termstrategyfordatasystemstosupportanalytics.ProjectTimelineandKeyFacts:• March2015–RFPreleasedfortheVCPDataRepositoryproject.• May2015–VCPDataRepositorySelectionCommitteeselectedpreferredvendor.• September2015–VCPDataRepositoryVendorcontractexecuted.• June2016–BlueprintClinicalRegistryMigrationtoVITLinfrastructurecomplete.• July2016–VCPDataRepositoryPhase1completed.• January2017–VCPDataRepositoryPhase2inprocess.• June2017–VCPDataRepositoryPhase3tobecompleted.
StatusUpdate/ProgressTowardMilestonesandGoals:• VCPDataRepositoryprojectworkdevelopedabehavioralhealth-specificdatarepositoryforDAsandSSAs,
whichwillaggregate,analyze,andimprovethequalityofthedatastoredwithintherepositoryandallowforsharingofdataextractswithappropriateentities.
• AsofMay2016,theVCPDataRepositoryprojecthadreceived100%ofmemberagencydataforCYs2014and2105.Thewebportalformemberagenciesisnearlyreadyforfunctionaltesting.AprototypeofadashboardincludingaKeyPerformanceIndicator(KPI)summary,demographicanalyses,servicedeliveryanalyses,staffservicedeliveryanalyses,andcrisisservicesanalyseswaspreparedforreviewandfeedback.Implementationofthisprojectbeganinlate2015andcontinuedthroughtheendof2016.
• TheBlueprintClinicalRegistryMigrationbeganinJanuary2016withtheacquisitionoftheclinicalregistrysoftware.ThesystemwasmigratedinSpring2016andsuccessfullywentliveinJune2016.
• TheVHCIPteamconvenedateamofStatestakeholderstodiscussstrategiesfordevelopingdatasystemstosupporttheState’sanalyticneeds,aswellasagroupofstakeholderstodiscussHITDataGovernance.ThisgroupprovidedproposalstotheState’shealthcareandHITleadershipinDecember2016.
Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:Preparetodevelopinfrastructuretosupportthetransmission,aggregation,anddatacapabilityoftheDAsandSSAsdataintoamentalhealthandsubstanceabusecompliantDataWarehouse:
1.Developdatadictionaryby3/31/15.2.ReleaseRFPby4/1/15.3.ExecutecontractforDataWarehouseby10/15/15.4.Designdatawarehousingsolutionsothatthesolutionbeginsimplementationby12/31/15.
PerformancePeriod2:1.ImplementPhase1ofDA/SSAdatawarehousingsolutionby12/31/15(implementationfollowsimplementationprojectplan).2.Procureclinicalregistrysoftwareby3/31/16.3.Developacohesivestrategyfordevelopingdatasystemstosupportanalyticsby3/31/16.
PerformancePeriod3:1.ImplementPhase2ofDA/SSAdatawarehousingsolutionby12/31/16.2.Obtainapprovalofcohesivestrategyfordevelopingdatasystemstosupportanalyticsby10/31/16.Operationalizetheapprovedcohesivestrategyfordevelopingdatasystemstosupportanalyticsby12/31/16.
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Metrics:CORE_HealthInfoExchange_[VT]AdditionalGoals: #LivesImpacted:35,000 #ParticipatingProviders:5,000KeyDocuments:• DataRepositoryRFP
StateofVermontLead(s):GeorgiaMaherasContractorsSupporting:BehavioralHealthNetwork/VermontCareNetwork;H.I.S.Professionals;StoneEnvironmental;VermontInformationTechnologyLeaders;TBD.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:• WorktowardthecohesivedatawarehousingstrategycomponentofthePerformancePeriod2milestonewas
beendelayed.o TheStateiscurrentlyworkingwithkeypartnerstodevelopacohesivestrategy;thisworkisexpectedtobe
completedduringPerformancePeriod3.
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FocusArea:HealthDataInfrastructureProject:CareManagementTools–SharedCarePlanProject(ProjectComplete)
ProjectSummary:TheSharedCarePlan(SCP)project(formerlypartoftheSCÜPproject)originallysoughttoprovideaSharedCarePlansolutiontoVermont’sproviderorganizations.AfterelectingnottopursueatechnicalSharedCarePlansolution,theprojectrefocusedonreviewingandrecommendingrevisionstoconsentpolicyandarchitecturetoenablesharedcareplanninginthefuture.ProjectTimelineandKeyFacts:• April2015–ThroughtheIntegratedCommunitiesCareManagementLearningCollaborative,theneedfora
technicalsolutionforSharedCarePlanswasidentified.UniversalTransferProtocol(UTP)andSCPprojectsarealignedunderasingleprojectnamedSCÜP.
• June2015–DiscoveryonalignedSCÜPprojectbegan.• July-October2015–Requirementsgatheringsessionswithmultiplecommunitieswereperformedandinitial
technicalandbusinessrequirementsdrafted.Requirementsvalidatedwithtargetcommunities.TechnicalAssessmentsofexistingorproposedsolutionsmeetingSCÜPusecaseswerereviewedforalignment.
• November2015–TechnicalproposalsubmittedtoHDIWorkGroupbySCÜPteam.SCÜPsplitintotwoprojects(SCPandUTP)duetoadifferenceinproposedsolutions.
• December2015-January2016–Continueddiscoveryactivities.• March2016–ProjectstaffrecommendedcontinuedreviewofconsentrequirementsforSharedCarePlans.A
technicalsolutionwasnotrecommended.• March2016-December2016–Continuedreviewofconsentrequirementsanddevelopmentof
recommendations.StatusUpdate/ProgressTowardMilestonesandGoals:• IntegratedCareManagementLearningCollaborativeCohort1communitiesrequestedsharedcareplanningtools
inApril2015.• FinalfindingsreviewedwithHDIWorkGroupinNovember2015andMarch2016.Atechnicalsolutionwasnot
recommended.• Aprojectplantodefineconsentrequirementsandfordiscoveryworkforaconsentmanagementsystemwas
presentedtotheHDIWorkGroupinOctober2016.TheHDIWorkGrouprequestedthatadditionaldetailbedevelopedbyasubgroupforDecember2016.
• TheHIEConsentManagementStatementofWorkwasproposedtotheHDIWorkGroupinDecember2016.FeedbackfromtheWorkGroupwillbeincorporatedintoanysubsequentworkin2017.
Milestones(allCareCoordinationToolsworkstreams):PerformancePeriod1:N/APerformancePeriod1Carryover:
1.Discoveryprojecttosupportlong-termcare,mentalhealth,homecareandspecialistprovidersthroughaUniversalTransferProtocolsolution:Reportdue4/15/15.2.EngageinresearchanddiscoverytosupportselectionofavendorforeventnotificationsysteminVermontby10/1/15.
PerformancePeriod2:Engageindiscovery,designandtestingofsharedcareplanITsolutions,aneventnotificationsystem,anduniformtransferprotocol.Createprojectplansforeachoftheseprojectsandimplementasappropriate,followingSOVprocedureforITdevelopment:
1.EventNotificationSystem:Procuresolutionby1/15/16andimplementaccordingtoprojectplanforphasedrollout.2.SCÜP(sharedcareplansanduniformtransferprotocol):Createprojectplanforthisprojectthatincludesbusinessrequirementsgatheringby9/30/15;technicalrequirementsby10/31/15;andfinalproposalforreviewby1/31/16.
PerformancePeriod3:1.EventNotificationSystem:ContinueimplementationofENSaccordingtocontractwithvendorthrough12/31/16.2.SharedCarePlan:RecommendrevisionstotheVHIEconsentpolicyandarchitecturetobettersupportsharedcareplanningby6/30/17.
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3.UniversalTransferProtocol:Supportworkflowimprovementsatproviderpracticesthroughexistingcontractsthrough12/31/16.4.Continueimplementationofcaremanagementsolutions,includingVITLAccess,supportingHomeHealthAgenciesandAreaAgenciesonAging.
Metrics:CORE_HealthInfoExchange_[VT]AdditionalGoals: #LivesImpacted:N/A #ParticipatingProviders:N/AKeyDocuments:
• SharedCarePlanandUniversalTransferProtocolFinalReport(May2016)StateofVermontLead(s):GeorgiaMaherasContractorsSupporting:BailitHealthPurchasing;im21;VermontInformationTechnologyLeaders.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Thisprojectiscomplete.
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FocusArea:HealthDataInfrastructureProject:CareManagementTools–UniversalTransferProtocol(ProjectComplete)
ProjectSummary:TheUniversalTransferProtocol(UTP)project(formerlypartoftheSCÜPproject)soughttoprovideaUniversalTransferProtocoltoVermont’sproviderorganizationstohelpprovidersacrossthecarecontinuumtoexchangecriticaldatathatwouldsupportateam-based,coordinatedmodelofcare,particularlyduringcaretransitions.AfterelectingnottopursueatechnicalUTPsolution,thisworkfocusedontransformingpracticeworkflowstomeetUTPgoalsinpartnershipwiththeIntegratedCommunitiesCareManagementLearningCollaborative.Thisprojectiscomplete.ProjectTimelineandKeyFacts:• September2014–Contractorim21beganUTPdiscovery.• February2015–DraftUTPcharterandfinalUTPreportsubmitted.• April2015–ThroughLearningCollaboratives,theneedforatechnicalsolutionforSharedCarePlanswas
identified;UTPandSCPprojectsalignedunderasingleprojectnamedSCÜP.• June2015–DiscoveryonalignedSCÜPprojectbegan.• July-October2015–Requirementsgatheringsessionswithmultiplecommunitiesperformedandinitialtechnical
andbusinessrequirementsdrafted.Requirementsvalidatedwithtargetcommunities.TechnicalAssessmentsofexistingorproposedsolutionsmeetingSCÜPusecasesreviewedforalignment.
• November2015–TechnicalproposalsubmittedtoHDIWorkGroupbySCÜPteam.SCÜPsplitintotwoprojects(SCPandUTP)duetoadifferenceinproposedsolutions.
• March2016–ProjectstaffrecommendedthattheUTPprojectworkwiththeLearningCollaborativestoprovidesupportservicestotransformpracticeworkflowstosupporttheUTPusecase.Atechnicalsolutionwasnotrecommended.
• September2016–IntegratedCommunitiesCareManagementLearningCollaborativelearningsessionfocusedontransformingpracticeworkflowstosupportcaretransitionsandtheUTPusecase.
StatusUpdate/ProgressTowardMilestonesandGoals:• FinalfindingsreviewedwithHDIWorkGroup.ProjectstaffrecommendedthattheUTPprojectworkwiththe
IntegratedCommunitiesCareManagementLearningCollaborativestoprovidesupportservicestotransformpracticeworkflowstosupporttheUTPusecase.TheSeptember2016learningsessionforLearningCollaborativecommunitiesfocusedonthistopic.
Milestones(allCareCoordinationToolsworkstreams):PerformancePeriod1:N/APerformancePeriod1Carryover:
1.Discoveryprojecttosupportlong-termcare,mentalhealth,homecareandspecialistprovidersthroughaUniversalTransferProtocolsolution:Reportdue4/15/15.2.EngageinresearchanddiscoverytosupportselectionofavendorforeventnotificationsysteminVermontby10/1/15.
PerformancePeriod2:Engageindiscovery,designandtestingofsharedcareplanITsolutions,aneventnotificationsystem,anduniformtransferprotocol.Createprojectplansforeachoftheseprojectsandimplementasappropriate,followingSOVprocedureforITdevelopment:
1.EventNotificationSystem:Procuresolutionby1/15/16andimplementaccordingtoprojectplanforphasedrollout.2.SCÜP(sharedcareplansanduniformtransferprotocol):Createprojectplanforthisprojectthatincludesbusinessrequirementsgatheringby9/30/15;technicalrequirementsby10/31/15;andfinalproposalforreviewby1/31/16.
PerformancePeriod3:1.EventNotificationSystem:ContinueimplementationofENSaccordingtocontractwithvendorthrough12/31/16.2.SharedCarePlan:RecommendrevisionstotheVHIEconsentpolicyandarchitecturetobettersupportsharedcareplanningby6/30/17.3.UniversalTransferProtocol:Supportworkflowimprovementsatproviderpracticesthroughexistingcontractsthrough12/31/16.
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4.Continueimplementationofcaremanagementsolutions,includingVITLAccess,supportingHomeHealthAgenciesandAreaAgenciesonAging.
Metrics:CORE_HealthInfoExchange_[VT]AdditionalGoals: #LivesImpacted:TBD #ParticipatingProviders:TBDKeyDocuments:
• SharedCarePlanandUniversalTransferProtocolFinalReport(May2016)StateofVermontLead(s):GeorgiaMaherasContractorsSupporting:BailitHealthPurchasing;im21;VermontInformationTechnologyLeaders.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Thisprojectiscomplete.
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FocusArea:HealthDataInfrastructureProject:CareManagementTools–EventNotificationSystem
ProjectSummary:TheEventNotificationSystem(ENS)projectimplementedasystemtoproactivelyalertparticipatingprovidersregardingtheirpatient’smedicalserviceencounters.VITLandtheVermontACOsworkedwiththeStatetoperformdiscoveryanddesignofproposedENSsolutions.TheselectedENSsolutionprovidesadmission,discharge,andtransferdatatoparticipatingproviders.ProjectTimelineandKeyFacts:• July2014–VITLbeganENSproject.• August2014-January2015–Proofofconcept,research,anddiscoverytosupportvendorselection.• September2015–Vendorselected.• March2016–Contractapproved.• April2016–Projectlaunch.
StatusUpdate/ProgressTowardMilestonesandGoals:• StateofVermontworkedwithVITLtoprocureanEventNotificationSystem.• Vendor(PatientPing)andVITLcompletedimplementationofall15VITLfeedsinPatientPingenvironment.• AsofApril1,2017,theENSservicewasprovidingalertsfor88,406lives,andwascontinuingtotargetexpansion
toallFQHCpatientsandtheVNAs.AdditionalexpansionworkistargetedfortheDAs/SSAs&SNFs.Milestones(allCareCoordinationToolsworkstreams):PerformancePeriod1:N/APerformancePeriod1Carryover:
1.Discoveryprojecttosupportlong-termcare,mentalhealth,homecareandspecialistprovidersthroughaUniversalTransferProtocolsolution:Reportdue4/15/15.2.EngageinresearchanddiscoverytosupportselectionofavendorforeventnotificationsysteminVermontby10/1/15.
PerformancePeriod2:Engageindiscovery,designandtestingofsharedcareplanITsolutions,aneventnotificationsystem,anduniformtransferprotocol.Createprojectplansforeachoftheseprojectsandimplementasappropriate,followingSOVprocedureforITdevelopment:
1.EventNotificationSystem:Procuresolutionby1/15/16andimplementaccordingtoprojectplanforphasedrollout.2.SCÜP(sharedcareplansanduniformtransferprotocol):Createprojectplanforthisprojectthatincludesbusinessrequirementsgatheringby9/30/15;technicalrequirementsby10/31/15;andfinalproposalforreviewby1/31/16.
PerformancePeriod3:1.EventNotificationSystem:ContinueimplementationofENSaccordingtocontractwithvendorthrough12/31/16.2.SharedCarePlan:RecommendrevisionstotheVHIEconsentpolicyandarchitecturetobettersupportsharedcareplanningby6/30/17.3.UniversalTransferProtocol:Supportworkflowimprovementsatproviderpracticesthroughexistingcontractsthrough12/31/16.4.Continueimplementationofcaremanagementsolutions,includingVITLAccess,supportingHomeHealthAgenciesandAreaAgenciesonAging.
Metrics:CORE_HealthInfoExchange_[VT]AdditionalGoals: #LivesImpacted:88,406asofApril2017 #ParticipatingProviders:TBDKeyDocuments:Lead(s):GeorgiaMaherasContractorsSupporting:VermontInformationTechnologyLeaders,PatientPing.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Noneatthistime.
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FocusArea:HealthDataInfrastructureProject:GeneralHealthData–DataInventory(ProjectComplete)
ProjectSummary:Vermontengagedacontractor,StoneEnvironmental,tocompleteastatewidehealthdatainventorythatwillsupportfuturehealthdatainfrastructureplanning.ThisprojectbuiltacomprehensivelistofhealthdatasourcesinVermont,gatheredkeyinformationabouteach,andcataloguedtheminaweb-accessibleformat.Theresultingdatainventoryisaweb-basedtoolthatallowsusers(bothwithintheStateandexternalstakeholders)tofindandreviewcomprehensiveinformationrelatingtotheinventorieddatasets.ThisprojectwascompletedasofDecember2015.ProjectTimelineandKeyFacts:• November2014–Contractexecuted.• December2014–Projectlaunched.• January2015–ProjectconvenedHealthDataInventorySteeringCommitteetoguidework.• January-May2015–Datasetdiscoveryandinitialinformationcollection;includingkeyinformantinterviews.• April-May2015–Datasetprioritization.• September-November2015–Datacollectiononprioritizeddatasets,recommendationsdevelopment.• November2015–DraftreportandrecommendationssubmittedandsharedwithprojectleadershipandHDI
WorkGroupco-chairsforfeedback.• December2015–FinalrecommendationspresentedtoHealthDataInfrastructureWorkGroup;finalreport
submittedtoprojectleadership;finalweb-accessibleinventorylaunched.StatusUpdate/ProgressTowardMilestonesandGoals:• Contractor,workingwithSOVstaffandkeystakeholders,identified~20highprioritydatasetsfordeeperdata
collection;additionaldatacollectionontheseprioritizeddatasetsbeganinMay2015andendedinSeptember.• Contractorengagedinresearchonpossibleportalframeworkoptions,andselectedasolutionalreadylicensed
bytheStateofVermont.• DraftreportsubmittedtocontractmanagerandsharedwithprojectleadershipandHDIWorkGroupco-chairsin
November2015.• Finalreportsubmittedandweb-accessibleinventorylaunchedinDecember2015.
Milestones:PerformancePeriod1:Conductdatainventory.PerformancePeriod1Carryover:Completedatainventory:
1.Draftanalysisofhealthcaredatasourcesthatsupportpaymentanddeliverysystemreformsby4/15/15.2.Finaldatainventorydueby10/31/15.
PerformancePeriod2:N/APerformancePeriod3:N/AMetrics:CORE_HealthInfoExchange_[VT]AdditionalGoals: #LivesImpacted:N/A #ParticipatingProviders:N/AKeyDocuments:• FinalHealthDataInventoryReport• SearchableHealthDataInventory
StateofVermontLead(s):SarahKinslerContractorsSupporting:StoneEnvironmental.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Thisprojectiscomplete.
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FocusArea:HealthDataInfrastructureProject:GeneralHealthData–HIEPlanning(ProjectComplete)
ProjectSummary:TheHIEPlanningprojectresultedfromaperceivedgapinhigh-levelplanningandresearchinlocalandnationwidebestpracticesforprovidingarobust,interoperableabilitytotransmitaccurateandcurrenthealthinformationthroughouttheVermonthealthcarelandscape.ThisprojectisconductingfurtherresearchonbestpracticesaroundimprovingclinicalhealthdataqualityandconnectivityresultinginrecommendationstotheHDIWorkGroup.Additionally,theHDIWorkGroupparticipatedonmultipleoccasionsinthe2015revisionofVermontHealthInformationTechnologyPlan,whichwasreleasedinJanuary2016.ProjectTimelineandKeyFacts:• December2014–ContractorselectedforHIEPlanningproject.• April2015-September2015–HIEPlanningprojectcontractingprocessputonholdpendingFederalapproval.• October2015–HIEPlanningworkbegan.• July2016–ConnectivityTargetsplanpresentedtoHDIWorkgroup.
StatusUpdate/ProgressTowardMilestonesandGoals:• Workisongoingwithcontractorsupport.• VermontHITPlanreleasedinJanuary2016;thePlanispendingapprovalattheGreenMountainCareBoard.• ConnectivityTargetspresentedandapprovedintheOctoberHDIWorkGroupmeeting.InDecember2016,the
ConnectivityTargetswerepresentedtoboththeSteeringandCoreTeams.TheSteeringteamprovidedfeedbackbutdidnotvoteasitlackedaquorum.TheCoreTeamsubsequentlyapprovedtheConnectivityTargets.Additionalparameterswererequestedandwillbeincludedinthenextversion,tentativelyscheduledforMarch2017.
Milestones:PerformancePeriod1:ProvideinputtoupdateofstateHITplan.PerformancePeriod1Carryover:N/APerformancePeriod2:
1.VHCIPwillprovidecommentintotheHITStrategicPlanatleast4timesin2015.2.HDIWorkGroupwillidentifyconnectivitytargetsfor2016-2019by6/30/16.
PerformancePeriod3:Finalizeconnectivitytargetsfor2016-2019by12/31/16.IncorporatetargetsintoSustainabilityPlanby6/30/17.Metrics:CORE_HealthInfoExchange_[VT]AdditionalGoals: #LivesImpacted:N/A #ParticipatingProviders:N/AKeyDocuments:StateofVermontLead(s):GeorgiaMaheras,LarrySandageContractorsSupporting:StoneEnvironmental.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AdditionalSupportingInformation:Thisprojectiscomplete.
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FocusArea:HealthDataInfrastructureProject:GeneralHealthData–ExpertSupport(ProjectComplete)
ProjectSummary:ThisisacompanionprojecttoalloftheprojectswithintheHealthDataInfrastructurefocusarea.TheseprojectsrequirespecificskillstosupporttheStateandstakeholdersindecision-makingandimplementation,includingITEnterpriseArchitects,BusinessAnalysts,andSubject-MatterExperts.ProjectTimelineandKeyFacts:• AccessedasnecessarytosupportvariousHealthDataInfrastructureprojects.
StatusUpdate/ProgressTowardMilestonesandGoals:• IT-specificsupporttobeengagedasneeded.• EnterpriseArchitect,BusinessAnalystandSubjectMatterExpertsidentified.
Milestones:PerformancePeriod1:N/APerformancePeriod1Carryover:N/APerformancePeriod2:ProcureappropriateIT-specificsupporttofurtherhealthdatainitiatives–dependingonthedesignofprojectsdescribedabove,enterprisearchitects,businessanalysts,andotherswillbehiredtosupportappropriateinvestments.PerformancePeriod3:ProcureappropriateIT-specificsupporttofurtherhealthdatainitiatives–dependingonthedesignofprojectsdescribedabove,enterprisearchitects,businessanalysts,andotherswillbehiredtosupportappropriateinvestments.Metrics:CORE_HealthInfoExchange_[VT]AdditionalGoals: #LivesImpacted:N/A #ParticipatingProviders:N/AKeyDocuments:StateofVermontLead(s):GeorgiaMaherasContractorsSupporting:StoneEnvironmental.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:Thisprojectiscomplete.
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FocusArea:Evaluation
FocusArea:EvaluationProjects:Self-EvaluationPlanandExecution;Surveys;MonitoringandEvaluationActivitieswithinPaymentProgramsProjectSummary:AllSIMeffortsareevaluatedtoassesstheimpactsonVermontanditsresidents,payers,andproviders.Theevaluationsoccurbyprogram,bypopulation,andbyregiontoensuretherearenounintendedconsequencesandtoenablestafftobetterexpandlessonslearnedquickly.SIM-supportedprojectsandtasksunderwayintheEvaluationfocusareaincludedevelopmentandexecutionofaState-ledEvaluationPlan;surveystomeasurepatientexperienceandotherfactors;andmonitoringandevaluationactivitieswithinpaymentprograms.ProjectTimelineandKeyFacts:
• March2016–State-ledEvaluationcontractexecuted.• December2016–State-ledSiteVisitReportdue.• April2017–LearningDisseminationPlandue.• May2017–State-ledProviderSurveyReportdue.• October2017–FinalState-ledEvaluationReport.• Annually–PatientExperienceSurveyforP4PandSSPs.• Annually–Paymentprogrammonitoringandevaluationactivitiesaccordingtospecifiedprojectplans.
StatusUpdate/ProgressTowardMilestonesandGoals:• Vermontisimplementingamixed-methodsstudythatincludessitevisits,keyinformantinterviewsandprovider
surveysfocusedon:careintegration,useofclinicalandeconomicdataforperformanceimprovement,andpaymentreformincentives.ThisincludescompilingandsynthesizingevaluationdatafromacrossVHCIPpilotstoinformfinalevaluationreporting,andcreatingalearningdisseminationplan.
• InFebruary2017,theprovidersurveytargeting509carecoordinationprofessionalswasfielded.AlsoinFebruary,aggregationandanalysesofdatacollectedtodatefromSIM-fundedpilotscontinued.
• InMarch2017,theprovidersurveytargeting1007advancedpracticeprofessionalswasfielded,andanalysisfromdatacollectedtodate,includingsub-grantresults,focusgroups,sitevisitsandinterviews,continued.AlsoinMarch2017,theState-ledevaluationteampresentedprogressandearlyfindingstotheGreenMountainCareBoardandtotheSIMEvaluationSteeringCommittee.Monitoringactivitiesincludeconductinganannualpatientexperiencesurveyandothersurveysasidentifiedinpaymentmodeldevelopment;analysesofthecommercialandMedicaidSharedSavingsProgramsaccordingtoprogramspecifications;andongoingmonitoringandevaluationofpaymentmodelsbyStateandcontractors.
Milestones:
Self-EvaluationPlanandExecutionPerformancePeriod1:
1.Procurecontractor:HirethroughGMCBinSept2013.2.Evaluation(external):
• NumberofmeetingsheldwithQualityandPerformanceMeasurementWorkGrouponevaluation(goal=2).• Evaluationplandeveloped.• Baselinedataidentified.
PerformancePeriod1Carryover:1.DesignSelf-EvaluationPlanforsubmissiontoCMMIby6/30/15.a.Elicitstakeholderfeedbackpriortosubmission.2.OnceapprovedbyCMMI,engageinPerformancePeriod1Carryoveractivitiesasidentifiedintheplan.
PerformancePeriod2:1.Procurenewself-evaluationcontractorby2/28/16toexecutecontractor-ledself-evaluationplanactivities.2.Continuetoexecuteself-evaluationplanusingstaffandcontractorresources.3.Streamlinereportingaroundotherevaluationactivitieswithin30daysofCMMIapprovalofself-evaluationplan.
PerformancePeriod3:ExecuteSelf-EvaluationPlanfor2016and2017accordingtotimelineforPerformancePeriod3activities.
SurveysPerformancePeriod1:N/A
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PerformancePeriod1Carryover:Conductannualpatientexperiencesurvey(PerformancePeriod1surveysonly):1.Surveysarecompletedby6/30/15forreportingaspartofthefirstperformanceperiodfortheMedicaidandcommercialSharedSavingsPrograms.
PerformancePeriod2:Conductannualpatientexperiencesurveyandothersurveysasidentifiedinpaymentmodeldevelopment:FieldpatientexperiencesurveystoVermontersparticipatinginthePCMHandSharedSavingsprograms–phase1todetermineimpactofPerformancePeriod2activitiesby6/30/16.PerformancePeriod3:Conductannualpatientexperiencesurveyandothersurveysasidentifiedinpaymentmodeldevelopment:FieldpatientexperiencesurveystoVermontersparticipatinginthePCMHandSharedSavingsProgramsby6/30/17.
MonitoringandEvaluationActivitiesWithinPaymentProgramsPerformancePeriod1:N/APerformancePeriod1Carryover:Conductanalysesasrequiredbypayersrelatedtospecificpaymentmodels.
•NumberofmeetingsheldwithQualityandPerformanceMeasurementWorkGrouponevaluation(goal=2by6/30/15).•Payer-specificevaluationplandevelopedforMedicaidSharedSavingsProgramaspartofStatePlanAmendmentapproval.•BaselinedataidentifiedformonitoringandevaluationofMedicaidandcommercialSharedSavingsProgramsby6/30/15.
PerformancePeriod2:1.ConductanalysesofthePCMHprogram(non-SIMfunded)accordingtoprogramspecifications:biannualreportingtoproviders.2.ConductanalysesofthecommercialandMedicaidSharedSavingsProgramsaccordingtoprogramspecifications:monthly,quarterlyreportsdependingontype.
PerformancePeriod3:1.ConductanalysesofthePCMHprogram(non-SIMfunded)accordingtoprogramspecifications(bi-annualreportingtoproviders).2.ConductanalysesofthecommercialandMedicaidSharedSavingsProgramsaccordingtoprogramspecifications(monthly,quarterlyreportsdependingonreporttype).3.TBD:APM,MedicaidVBP–MentalHealthandSubstanceUse.
Metrics:CORE_BMI_[VT]CORE_DiabetesCare_[VT]CORE_EDVisits_[VT]CORE_HRQL_[VT]CORE_Readmissions_[VT]CORE_TobaccoScreeningandCessation_[VT]CAHPSClinical&GroupSurveysAdditionalGoals: #LivesImpacted:AllVermontersimpactedbyVHCIP. #ParticipatingProviders:AllVermontprovidersimpactedbyVHCIP.KeyDocuments:
• State-Led-EvaluationPlanLead(s):KathrynO’Neill(State-LedEvaluation);PatJones,JenneySamuelson(Surveys);AliciaCooper,PatJones(MonitoringandEvaluationofPaymentPrograms)ContractorsSupporting:JohnSnowInc.;Datastat;BailitHealthPurchasing;BurnsandAssociates;TheLewinGroup.Toviewexecutedcontracts,pleasevisittheVHCIPContractspage.AnticipatedRisksandMitigationStrategy:
• Vermont’ssmallpopulationpresentsmonitoringandevaluationchallengesduetosmallnumerators/denominatorsforsomemeasures.
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