The Green Mountain Care Boardand

VMS Education and Research Foundation

Actualizing reform thru clinician leadership

Better quality, Better health, Lower costs

January 9th, 2014

Optimizing hospital care Better care, better health, lower costs

You have to have the will to improve;You have to have ideas about alternatives to the status quo; andYou have to make it real through execution

All three have to be arranged by leaders – they are not automatic

How can leaders accelerate innovation?

1. A population-based care plan2. Anticipation of workforce needs3. Coordination of care across settings4. Transparency of payment reform5. Meaningful actionable measurement

1. Actualizing hospital reform thruclinician leadership

Better care, better health, lower costs• Region-wide bed-board triage

system• Hospital, rehab and SNF• CMS waivers• Patients located by need, not

facility revenue or compliance

Avoid transfusions of red blood cells for arbitrary hemoglobin or hematocrit thresholds and in the absence of symptoms of active coronary disease, heart failure or stroke.

Five Things Physicians and Patients Should Question

Optimizing rural careBetter care, better health, lower costs

1. Reduce the gap between practice and policy

2. Actualize 3 planned levels of care3. Become the national benchmark for

measurement4. Make VT a magnet for the workforce

“Our current clinical capabilities are such that we never lose a life because we are missing capacity when a life threatening situation presents itself; but we are all really stressed ”

-Rural health system medical director

2. Actualizing rural reform thru clinician leadership

Better care, better health, lower costs

Reduce policy gap“My biggest hope is that reform will work,

but my biggest fear is that it will not.There needs to be physician buy in. There

needs to be a critical mass of engaged supportive physicians “

primary care physician 

The Vermont Academy of Family Physicians will be hosting a VMS Foundation conference on Saturday, January 25, 2014 for all VT clinician leaders wanting a say in reform

Capitol Plaza Montpelier 8 a.m. – 12 p.m.  

Actualizing rural reform• Recommendations for change • 3 focus areas from the Rural Whitepaper:

1. Measuring things that matter to patients and practices;

2. Integrating social and community services with clinical services; and

3. Planned community-based and regionalized clinical services

• 3 breakout groups1. Broaden and refine clinician input2. Discuss recommendations for change to

be considered by the GMCB

• Plenary session report out and discussion• Written conference summary• 2nd GMCB presentation in February

3. Actualizing VT reform - clinician leadership

VT Clinician Leadership Institute (VCLI)• 9 month curriculum• 20-30 Fellows each class• Licensed VT clinical practitioners• Leadership awareness/skill building• Management knowledge/skills• Health Policy and Reform – fed/state• Individual leadership projects (MOU)• Network/pipeline of clinician leaders• Workforce engaged in reform

VCLI - Business plan• Design - Feb 2014 – Sept 2014

– Tuition commitments– Advisory committee– Faculty RFP

• First class Sept 2014 – June 2015• Funding depends on value

• Self-sustaining thru tuitions• Pooled tuitions – 5 scholarships• 80 CMEs (CEUs)• MBA credits

4. Mental health/Substance abuse community of clinician leaders

• Clinician leaders with shared interest in reform• Community champion – respected clinician leader • Recruitment of MH/SA clinician leaders• Research design – Actualizing MH/SA Reform

– Face to face meetings– Conference calls– Web based resources

• Research activity period• Whitepaper - Actualizing MH/SA reform

– Fall 2014 GMCB presentation– Recommendations and action steps

Actualizing reform thru clinician leadershipBetter care, better health, lower costs

1. Hospital reform– Hospital clinician leaders– Region-wide triage system– CMS waivers– Choosing Wisely –

Transfusions

2. Rural reform– Jan 25 Work Session– Broaden leadership input– Develop reform action steps– Reform project(s) with GMCB

3. Engaged workforce– VCLI– Feb 2014 – Sept 2014

• Design/Commitments

– Sept 2014 – June 2015– Individual reform projects– Pipeline of future leaders

4. MH/SA reform– MH/SA clinician leaders

community– GMCB whitepaper Dec 2015

• Action steps

The Green Mountain Care Boardand

VMS Education and Research Foundation

Actualizing reform thru clinician leadership

Better quality, Better health, Lower costs