Blueprint for Health Report: Medical Homes, Teams and Community Health Systems

Introduction. During the 2014 legislative session, the Vermont General Assembly passed Act No. 144, an Act Relating to Miscellaneous Amendments to Health Care Laws. Section 17, Chronic Care Management; Blueprint Report; requires that on or before October 1, 2014, the Secretary of Administration or designee shall recommend to the House Committees on Health Care and on Human Services and the Senate Committees on Health and Welfare and on Finance whether and to what extent to increase payments to health care providers and community health teams for their participation in the Blueprint for Health and whether to expand the Blueprint to include additional services or chronic conditions such as obesity, mental conditions, and oral health.

The recommendations in this report reflect input from meetings with clinicians and providers in areas across the state, input from Vermont’s major commercial insurers and Medicaid, input from administrative leaders of hospitals, health centers, and Vermont’s three Accountable Care Organizations, and input from a large and diverse set of stakeholders as part of the Blueprint’s Executive and Planning committee meetings. The Director of the Blueprint Program, in collaboration with the Chair of the Green Mountain Care Board, and healthcare reform leadership within the Administration, have prepared this report to provide the Legislature with the recommendations requested in Act 144, and to submit these recommendations in the context of a more complete plan for the Blueprint program to support the next phases of Vermont’s healthcare reforms. 

In 2013, lower healthcare expenditures for participants offset the payments that insurers made for medical homes and community health teams, a finding that was similar in 2012 (Table 4). It is difficult to fully incorporate the cost of administration at all levels, however, and the figures included in Table 4 are not all inclusive of in kind participation or grants. Overall, these results suggest a positive gain to cost ratio for insurers and their customers, better healthcare for citizens, and they provide an objective rationale for continuing medical home and community health team operations. More importantly, the results highlight that capitated population based payments which are targeted toward specific goals, in conjunction with transformation support through Blueprint grants, can lead to structural and behavioral changes that improve health services and cost outcomes.