1.        Convene, Review and Approve Meeting Minutes from August 26, 2008        

                                                                                                                      CD #1, TR. 1

 

Sen. Kitchel convened the Commission meeting at 1:40 PM. 

The Commission approved the minutes from August 26, 2008, as corrected.

Correction: Pg. 3: Northeast Vermont Regional Hospital should be on the list of hospitals that ARE ready for interconnection.

 

2.        Progress Report on Blueprint for Health Implementation                 

                                                                                                                      CD #1, TR. 2

                      Craig Jones, MD, and Lisa Dulsky Watkins, MD

 Documents distributed:

• Doc. #1: Blueprint Integrated Pilot Programs -- PPT
• Doc. #2: Vermont Blueprint HCRC Meeting, Craig Jones, Overview, etc.

 

1. Overall review of general Blueprint activities:

There are six funded communities:

St. Johnsbury

Bennington

Mt. Ascutney

Springfield

Central Vermont

Fletcher Allen

 

They have added two new medical conditions to the new RFP: hypertension and asthma.

Evaluation: it has five tiers. Contracted with the Vermont Child Health Improvement program at UVM. They do chart reviews; also did a qualitative report, including using focus groups in Blueprint communities.

These reports are on the VDH website.

 

Staffing: the Blueprint office is finally fully staffed. Jim Morgan is the statewide project manager; Jennie Samuelson is the communications and self-management leader.

They do need a chronic disease prevention designee in each of the Blueprint offices around the state—to fulfill goals of legislation. Will coordinate the issues of health care and public health in each area, and help support the implementation of the legislation. (This is a broad and ambitious charge.)

Concerns that half-time positions my not be able to do all that is requited. Three Blueprint communities still need this part-time coordinator.

 

Commissioners shared concerns re the level of staffing and the work that’s expected—especially due to the new rescissions. The November HCRC meeting will focus on these issues—hope to have the VDH Commissioner or Deputy Commissioner attend to discuss this.

 

Re Act 203, Section 19: Blueprint and Obesity Treatment and Prevention: They are reassessing the toolkit re obesity issues.

 

Discussion re children and whether they are served by this obesity initiative. The toolkit is for adults; but they now have a best practices work group set up, on obesity overall. The work is how to make the essential linkages. They are testing interventions in three care environments:

1. The pilot communities, with intensive resources
2. Regular Blueprint environments
3. No Blueprint at all

 

Self-Management:

There are now Healthy Living workshops almost statewide. They are based on the Stanford model. They are seeing enrollment challenges—as discussed during this morning’s presentation from the St. Johnsbury Integrated Blueprint Pilot.

They are doing leadership trainings, and the Blueprint pilot project managers are meeting as well. In addition, they are planning an on-line pilot.

 

Information Technology and the Blueprint:

Discussion of DocSite and connectivity: Specific support to pilots re interface management.

They sent an RFP to four Blueprint non –pilots. They have received two proposals (Bennington and Central Vermont) and are reviewing them now. They plan on an Oct. 1 decision.

There are challenges re adoption and learning.

 

Key next steps?

1. Bring on next pilot sites.
2. Collect data on the model—maybe it will support the model, maybe not. Experience over time is necessary. There can be a rapid uptake once the initial learning happens.
3. Let the pilots collect experience, become ambassadors.
4. Expanded work: broader set of medical conditions; comparative data collected.
5. Information tools—IT is key to support the roll-outs.

 

Blueprint Integrated Pilot Programs

CD #1 Tr. 3

Dr. Jones reviewed the schematic re the Transformation Process: Funding / Programs / Products.

 

Components of the Pilot:

1. Financial reform
2. Multidisciplinary care support teams (CCT teams)
3. Health Information Technology
4. Community Activation and Prevention
5. Evaluation

 

Mentioned: Elliott Fisher editorial, “Building a Medical Neighborhood for the Medical Home” –

New England Journal of Medicine, Volume 359:1202-1205, September 18, 2008, Number 12

http://content.nejm.org/cgi/content/full/359/12/1202

 

Extended discussion of IT and support; discussion of the pilot’s impact in St. Johnsbury re staff.

 

Dr. Jones explained the pilot participants in each pilot site. With the third pilot to be added, they will be covering close to one tenth of the state population.

 

The Blueprint Pilot, Timeline and Evaluation:

·    Categories

·    Data Sources

·    Evaluation Outline

CD #2 Tr. 1

They are working on a financial model to predict outcomes of the Blueprint model on projected health care costs. It is now being presented to the Blueprint executive committee; will be presented to others, including the HCRC, later.

 

Q:  Future rollout beyond the three initial communities? (Subject, of course, to evaluation data.)

A: Yes, always subject to the evaluation results:

Expanding other Blueprint communities (the non-integrated pilot sites);

With each community, focus on gaps, needs. Aggressive effort;

Then expand to communities that aren’t yet involved with the Blueprint at all.

 

3.        Health Care Reform Implementation                                                 

                      Susan Besio

CD #2 Tr. 2

Working with Steve Kappel, they have done an analysis:

47% of eligibles age 56-64 have enrolled in the two programs, 38% of age 18-35 have done so.

They are working on getting a prominent Vermonter to be a spokesperson—especially to 18-35 year-olds.

BCBS and MVP have agreed to wait to raise rates until July 1, 2009—rather than January 1, 2009.

 

The Rules for the Multi-Payer database have been approved by the Legislative Committee on Administrative Rules (LCAR). They are now being implemented.

 

The Administration is now reviewing VITL’s application for funding. They are working with VITL to prioritize projects and spending in case the funds collected come up short.

 

The Arcadia project:  They will fund part of this work re EMRs. Other funding as well, re electronic interfaces.

 

They continue to revise and improve the website:

http://Hcr.vermont.gov

 

They are also continuing to revise and update the Health Care Reform report.

 

4.        Draft Commission Statement on Health Care Costs

                      Steve Kappel

CD #2 Tr. 3

Document distributed:

• Doc. #3: Draft Statement from Health Care Reform Commission on Uncontrolled Health Care Costs

A group, including Sen. Racine, Rep. Larson, Rep. Maier and Sen. Kitchel and HCRC staff has worked on this, and has produced this draft.

 

Discussion of the draft, various proposed changes (Steve Kappel took notes). Commissioners referred the draft back to Steve Kappel and Don Dickey for redrafting. The next draft will go out to a wider group for comment, then be revised again and brought to the Commission again.

 

One suggestion: Have discussion with media representatives, re education and broader issues; possible other media outreach.

 

5.        Commission Staff Update                                                        

                      Jim Hester

CD #2 Tr. 4

           a.        VITL status: grant application and governance:

The full VITL board has accepted the recommendations of the governance group; now they have the new board and officers in place, the first meeting of the new board was last Wednesday.

 

           b.        Commission Studies for 2008-9:

a)     ACO Feasibility study is moving along. Will have a first meeting of the Work Group next week; have distributed a number of working papers. Will discuss a working design for an ACO next week. Need to review and prioritize issues.

b)     Study on Merging Risk Pools has begun. Elliot Wicks is working on this.

c)     Electronic prescribing feasibility study (ePrescribing)—Consultants, Point-of-Care Partners, have been working on the first phase, just about completed. Will be a work group session at the end of October. New Hampshire has a state-wide initiative, sponsored by Blue Cross; other states are working on this as well.

d)     Study on Public Financing is also moving along. They are clarifying the questions; Steve Kappel is soliciting input re the questions and the components to review; he is also working on a baseline analysis on what the level of public financing currently is—where are we now.

 

Q: Timeline re Public Financing study?

A: They are working on interim deadlines; Jim will get back to commissioners re that.

 

Note from Hunt Blair, Bi-State Primary Care Association:  re tele-medicine and child psychiatry: they have just received a grant for $183,000 for components and hardware.

The Medicaid Advisory Board is looking into this as well—there may be an opportunity to pilot a program on this.

Re the status of the 340B Pharmacy—community pharmacy: will be opening and operation on Oct. 6^th, pending final federal approval. Will be online—five community health centers.

 

Discussion re pharmacy board and automatic drug prescription units to be installed in several community health centers; 340B wholesale pricing.

 

Sen. Kitchel: A possible focus for a future Commission meeting: pharmaceuticals, many topics, including:

·    Academic detailing

·    Elders with multiple drug prescriptions

·    340B issues and health centers

·    The Corrections Department and pharmacy issues.

 

Rep. Maier: make a note to include information on pharmacy programs in the Statement on Costs, and in Susan Besio’s PowerPoint on health care reform.

 

 

6.        Commission meeting schedule:  November 6: Montpelier

 

The next Commission meeting will be Thursday, Nov. 6. This is two days after the Tuesday Nov. 4 election day.

A major agenda item will be a review of prevention initiatives.

 

There will also be a discussion of the issues relating to prescription drugs. Please send suggested topics for this discussion to Jim Hester.

 

Re setting a December Commission meeting date: Jim will poll commissioners via e-mail re setting that date.

 

The meeting adjourned at 4:00 PM.

 

Respectfully submitted,

Loring Starr