Sharon Moffatt RN MSN Acting Commissioner of Health November 6, 2006.

Sharon Moffatt RN MSNActing Commissioner of HealthNovember 6, 2006

The Vermont Department of Health

The Vermont Blueprint for Health…

… gives people with chronic conditions the information, tools and

encouragement they need to be successfully to manage their health

The Vermont Department of Health

Why is change needed?Growing health care costs

Vermont health care costs 11.5% from 2001

Vermont Medicaid expenditures 13.4 % since 1997

All insurers expenditures 9.2% since 1997

The Vermont Department of Health

Cost of Chronic Conditions is both Personal and Financial

Care for people with chronic conditions accounts for:• 83% of health care spending• 81% of hospital admissions• 76% of all physician visits• 91% of all prescriptions filled

The Vermont Department of Health

Vermonters with Chronic Disease

Percent of Vermont Adults with Chronic Diseases

2001

0%10%20%30%40%50%60%70%80%90%

100%

None 1 or more 2 or more 3 or more 4 or more

all ages 65+

The Vermont Department of Health

The Vermont Department of Health

The Cost of Obesity

One-third of total direct health care costs in the U.S. are related to

15 Diseases Associated with Obesity

Medical expenses attributable to

Adult Obesity in Vermont

141 Million Annually

The Vermont Department of Health

Vermont Obesity Trends

53% of Vermont Adults are

obese or overweight

OR

226,615 Vermonters are

above

a healthy weight

The Vermont Department of Health

Deaths Per Thousand Adults

2.50

2.25

2.00

1.75

1.50

1.25

1980 1990

2000

2010

2020

2030

2040

2050Time (Year)

No Change

Obesity Prevention

Better Care

Reducing diabetes deaths: options

The Vermont Department of Health

Deaths from complications–per thousand Adults

No major changes – status quo

Care and reduction in caloric intake

2.50

2.25

2.00

1.75

1.50

1.25

1980 1990 2000 2010 2020 2030 2040 2050

Time (Year)

Obesity Prevention and Better Care

No Change

Reducing diabetes deaths: comprehensive approach

The Vermont Department of Health

Vermont Blueprint

A system of care that enables Vermonters to lead healthier lives

A system of care that is financially sustainable

inable;and,

A public-private partnership

that sustains

the new system of care

The Vermont Department of Health

The Chronic Care Model

Informed,ActivatedPatient

ProductiveInteractions

Prepared,ProactivePractice Team

Functional and Clinical Outcomes

DeliverySystemDesign

Decision Support

ClinicalInformation

Systems

Self-Management

Support

Health System

Resources and Policies

Community

Organization of Health Care

System of Care

The Vermont Department of Health

Social Ecological Model

Behavior change influenced at all levels

Individual

Interpersonal

Public Policy

Community

Organizational

The Vermont Department of HealthVermont Blueprint Model for Health

HealthyVermonters

Patients and Families

Community

HealthProvider Team

•Practice standards•Office Systems•Support•Information Systems

•Built Environment•Health Services•Health Awareness•Healthy Options•Information Systems

Health Systems

Public PolicyPublic Health

•System policy•Quality care•Reimbursement•Financing•Continuity•Coordination•Information Systems

•Policies•Infrastructure•Financing•Resources•Advocacy•Regulation•Information Systems

•Health knowledge•Self-manage- ment skills•Supportive home environmentInformation Systems

Blueprint Partnership

The Vermont Department of Health

Self Management Healthy Living Workshops

The Vermont Department of Health

Community

The Vermont Department of Health

Community9%

Self Management

9%

Provider Practice

9%

Clinical Registry System

66%

Health Systems7%

Blueprint Budget 2006 By Focus Area

The Vermont Department of Health

Blueprint for Health—FY 06Self Management•6 Master Trainers•45 Instructors•200 participants •(200 more by 6/30)•15 towns•5 VDH staff

Health Systems•Disease Management Report•Pay 4 Performance(study started)•1 VDH staff (PT)

InformationSystems•VHR to practices•Registry Selected•Practice needs Analysis•4 VDH staff

Provider Practice•Pilots:

•19 Practices•45 Providers•1200 patients

•Others: 20 practices•1VDH staff (PT)

Community Services•5 Communities•10 District offices•18 towns-physical activity•VT-211 in 2 pilot communities•28 VDH staff participate

The Vermont Department of Health

Healthy Living ParticipantsMedical Care

6.7

5.3

3.8

Baseline 6 Months 12 Months

0.56

0.430.38

Baseline 6 Months 12 Months

MD Visits ED Visits

Both visits to a doctor’s office and visits to the ED went down significantly at six and 12 months

The Vermont Department of Health

Daily ActivitiesFor many participants, after 12 months, their health condition does not interfere with

their daily activities such as social activities with friends, hobbies, recreational activities and household chores.

54%

33%38%

60%53% 55%

Does Not Interfere With Normal SocialActivities

Does Not Interfere With Hobbies/RecActivities

Does Not Interfere With HouseholdChores

0 month 12 month

The Vermont Department of Health

Physical Activities And AbilitiesThere is an increase in the number of participants who are able to walk at least 30-60

minutes a week.

Many report having no difficulty walking outdoors, dressing themselves, and picking up clothes from the floor

51%57%

63%

52%

61%

72% 72%

61%

Walk at Least 30 Min/Wk No Difficulty Walking Outdoors No Difficulting Dressing No Difficulty Picking upClothing

0 month 12 month

The Vermont Department of Health

Resources/References

The Chronic Care Model: Improving chronic illness care a national program of The Robert Wood Johnson Foundation, www.improvingchroniccare.org

Wagner, E.H. Chronic Disease Management: What will it take to improve care for chronic illness? Effective Clinical Practice 1998;

12-4.

The Vermont Department of Health

Resources/References

The Model for Improvement by the Institute for Health Improvement www.ihi.org

The Quality of Health Care Delivered to Adults in the United States. New England Journal of Medicine 2003, 348:26.

The Vermont Department of Health

Best Practice Guidelines

Agency for Healthcare Research and Quality www.guidelines.gov

Institute for Clinical Systems Integration www.icsi.org

American Diabetes Association www.diabetes.org

American Heart Association www.americanheart.org

The Vermont Department of Health

Vermont Blueprint for Health

www.healthvermont.gov