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State Partnerships to Improve Quality: Models and Practices from Leading States Issue Brief
/in Policy Reports /by NASHP StaffThe National Academy for State Health Policy identified ten leading state quality improvement partnerships – interrelated broad-based partnerships, mostly with public and private sector representation, which have long-term, statewide, systemic quality improvement strategic intent, and transparent agendas. This State Health Policy Briefing summarizes results of NASHP’s full report examining these partnerships in Colorado, Kansas, Maine, Massachusetts, Minnesota, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington. The key factors, policies, and practices that influence the quality improvement partnerships in these 10 states offer insights for achieving systemic improvement in health care quality and performance. The full report is also available.
| QI Models and Practices | 136.6 KB |
State Partnerships to Improve Quality: Models and Practices from Leading States Report
/in Policy Reports /by NASHP StaffThis NASHP-led, Commonwealth Fund-supported report highlights ten leading state quality improvement partnerships, broad-based, public-private partnerships that strive for long-term, statewide, and systemic quality improvement. This report describes the state partnerships’ origins, internal processes, accomplishments, and lessons learned, as well as their five strategies for achieving quality improvement. The factors and policies that influence the 10 featured state partnerships offer key insights for achieving systemic improvement in health care quality and performance. The report features state partnerships in Colorado, Kansas, Maine, Massachusetts, Minnesota, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington.
| Quality Improvement Partnerships | 440.3 KB |
Vermont
/in Policy Vermont /by NASHP StaffORIGIN AND MISSION
The State of Vermont, under the leadership of its governor, legislature and the bipartisan Health Care Reform Commission, has established a program called the Blueprint for Health. The Blueprint is guiding a comprehensive and statewide process of transformation designed to reduce the health and economic impact of the most common chronic conditions, and to focus on their prevention. The state’s strong commitment is demonstrated in the 2006 statutory codification of the Blueprint as the state’s plan for changing health care delivery. Further legislation in 2007 and 2008 strengthened the involvement of private insurance carriers. The annual state budget supports the health care transformation process, along with expanded use of health information technology and the development of a statewide health information exchange network.
The Blueprint is a vision, a plan, and a statewide partnership to improve the state’s health care system and the health of Vermonters. It aims to shift the focus of the health care system to preventing illness and complications. The Blueprint started as an initiative to create a chronic care infrastructure and uniform model for providing chronic care in Vermont (its original pilot sites focused on diabetes). It has developed into a statewide health reform project that spans agencies and addresses the general population. The Blueprint quality improvement components include improved health maintenance, prevention, and chronic care management for a general population; financial reform that aligns incentives with health care goals; expanding the use of health information technology supported by an information exchange infrastructure; and a reporting and evaluation infrastructure that supports individual patient care, population management, quality improvement, and program evaluation.
GOVERNANCE
The director of the Vermont Blueprint reports to the commissioner of health and is responsible for implementing the program. The director coordinates the program across all levels of state government and with non-government partners. Blueprint goals are defined by the governor and legislation. The Blueprint is expected to work across agencies, sectors of society, and public-private partnerships. The director works with an Executive Committee, and a Planning & Evaluation Committee, as well as with advisory workgroups as needed.
The FY 2009 Blueprint budget is about $4.8 million. The FY 2010 budget is just more than $4 million. Funding comes from the state’s global commitment (Medicaid program waiver savings) and the Catamount Fund (which includes Master Tobacco Settlement payments and an increase in cigarette tax).
ACTIVITIES AND ACCOMPLISHMENTS
Over the last three years, six Blueprint communities (authorized under Act 191) have implemented improved diabetes care and prevention via provider training and incentives, expanded use of health information technology, evidence-based process improvements, statewide self-management workshops, and statewide support for community activation and prevention programs.
Legislation (Act 71, 2007 and Act 204, 2008) authorized the Blueprint to select three communities to participate in the Blueprint Integrated Pilot Program (BIPP) to assess the efficacy and sustainability of comprehensive, multi-payer reform for a general population. Blueprint supports participating pilot practices by helping them operate a patient-centered medical home (PCMH). A multidisciplinary Community Care Team provides care support for the PCMHs in a community. BPIPP also includes an infrastructure for multidimensional evaluation that encompasses measures of clinical processes, health status, and health care patterns and expenditures (via claims data from a multi-payer database populated by information from all insurers and third party administrators), as well as return on investment and financial impact.
BIPP practices receive:
• Enhanced payment for meeting National Committee for Quality Assurance (NCQA) PCMH standards.
• Local multidisciplinary care support teams called Community Care Teams (CCTs), which include public health prevention specialists.
• A web-based clinical tracking system.
• Health information exchange between electronic medical records, hospital data sources, and a web-based clinical tracking system.
BIPP Partners include:
• Private and public payers who share the costs of CCTs and have a common payment structure based on a practice’s NCQA PCMH score.
• Vermont Information Technology Leaders (VITL), a hospital and systems integration effort that supplies the HIE network and provides comprehensive data services that help practices implement EMRs.
• Vermont Program for Quality in Health Care (VPQHC), a private, non-profit corporation formed in 1988 with which the Blueprint has contracted to coordinate provider training and work with communities. VPQHC also provides registry reports via the Vermont Health Record (its chronic disease registry tool) and the web-based clinical tracking system.
Financing State Coverage Expansions: Can New Medicaid Flexibility Help?
/in Policy Reports /by NASHPAs states like Massachusetts, Vermont, and Maine continue to implement their health reforms, other states are also considering ambitious coverage expansions. Financing is a key concern. In the past, states interested in drawing down federal Medicaid funds to expand coverage had two primary mechanisms available to them: filing a state plan amendment using available optional eligibility categories and income disregards, or applying for a Section 1115 waiver. Under the first approach, states are required to provide all the Medicaid mandatory benefits, and to cover all people who meet the eligibility standards, with full federal financial participation guaranteed. The waiver approach gives states flexibility in areas like benefit design and eligibility, but limits the amount of federal financial participation because of budget neutrality requirements.
Under the Deficit Reduction Act of 2005 (DRA), a new approach is available that gives states some of the flexibility of the §1115 waiver, but without a cap on federal financial participation. Although at first glance the DRA did not appear to be a vehicle for expanding coverage, a closer read reveals that the DRA’s language actually allows states to use their new flexibility with benefits design, coupled with income disregards in existing categories, to expand coverage. This new flexibility, combined with long-standing Medicaid authority to expand eligibility by disregarding income, allows states to file state plan amendments in order to expand coverage to higher income populations in plans that look more like commercial insurance and charge limited premiums. Since the DRA became law, the Centers for Medicare and Medicaid Services (CMS) has urged states to make these types of changes through state plan amendments using new DRA authority rather than through §1115 waivers.
This State Health Policy Briefing provides a roadmap of options made possible with new authority in the DRA that may make it easier for states to finance coverage expansions with federal matching funds. It describes:
• the key language in the DRA,
• the long-standing authority to expand eligibility to certain Medicaid eligibility groups through income disregards,
• the new benefits and cost-sharing flexibility provided in the DRA, and
• how this authority might support state coverage expansions.
| shpbriefing_financingexpansions.pdf | 360 KB |
Care Coordination for People with Chronic Conditions
/in Policy Reports Chronic and Complex Populations /by NASHPThis paper explores the components of care coordination and a sample of state initiatives that bridge the health and supportive systems.
| care_coordination.pdf | 341.3 KB |
SCHIP and Adolescents: An Overview and Opportunities for States
/in Policy Reports /by NASHPOver the past decade, the State Children’s Health Insurance Program (SCHIP) has made great strides in increasing health care coverage among youth under age 19. However, this overall success masks an important disparity – adolescents are more likely to be uninsured than younger children. As state policy makers and program administrators seek to build on their successes to reach more of those eligible for SCHIP, special attention should be paid to adolescents. SCHIP coverage can not only improve teens’ health, but can reduce the burdens of chronic disease in adulthood.
Adolescents have distinct service utilization and developmental health care needs, which should be addressed in the design of each state’s SCHIP program. Outreach, benefits, service providers, and quality measurement and improvement are all program elements that can be examined and tailored to meet adolescents’ needs.
This State Health Policy Briefing provides an overview of adolescents’ characteristics and health care needs and offers guidance on how to tailor state SCHIP programs to better target the health care needs of low-income adolescents.
| SCHIP and Adolescents | 191.8 KB |
Vermont
/in Policy Vermont /by NASHP StaffIn 2006 , Vermont required the commissioner of health to establish a comprehensive patient safety surveillance and improvement system for the purpose of improving patient safety, eliminating adverse events in Vermont hospitals, and supporting and facilitating quality improvement efforts by hospitals.
| Authorizing statutes or regulations | Vermont Statues, Title 18, Chapter 43A | |
| Authorizing statutes or regulations | Vermont Statues, Title 18, Chapter 3, Section 102 | |
| Authorizing statutes or regulations | Vermont Statues, Title 18, Chapter 43A, Section 1914 | |
| Authorizing statutes or regulations | Vermont Department of Health, Patient Safety Surveillance and Improvement System Rule | |
| Legislative reports | 2008 Report to the Legislature | |
| State website | Patient Safety Surveillance and Improvement System | |
| State website | Vermont Department of Health | |
| User’s guide for facilities | Patient Safety Electronic Reporting System |
Vermont
/in Policy Vermont /by NASHP StaffThrough the ABCD project Vermont integrated three home visiting programs into one –Healthy Babies, Kids, and Families. The paperwork associated with assessment, referral, and monitoring was streamlined (from seven forms to one); eligibility was expanded (from 12 months to five years); and services were added to include home visiting with case management, phone consultation, targeted educational materials that highlight child development, and group education for parents and care givers.
Vermont also trained physicians, public health providers, child care providers, and government officials in developmental issues using Touchpoints (a curriculum that emphasizes the building of supportive alliances between parents and professionals around key points in the development of young children). In doing so, Vermont changed the focus of its work with families to a developmental approach, rather than a risk-based one.
| Title | Description | Date Published | Activity |
| Children’s Integrated Services Referral Form | (Vermont Department For Children and Families) This is the referral form developed by Vermont DCF for use with the Children’s Integrated Services Program. The form is used to refer to nursing & family support, early intervention, and early childhood and family mental health services. | January 2013 | Care Coordination and Linkages to Services and Improving Policy |
| Children’s Integrated Services Program Handout | (Vermont Department for Children and Families) This is a handout for families that was developed by Vermont DCF. The handout describes the purpose of the Children’s Integrated Services (CIS) Program as well as the services it provides to families. | December 2012 | Care Coordination and Linkages to Services and Engaging Families |
| Children’s Integrated Services Program Booklet | (Vermont Department for Children and Families) This is a booklet put together by Vermont DCF to describe the services available to families through the Children’s Integrated Services Program (CIS). The CIS program is the name for Vermont’s approach to providing coordinated child development and family support services. | December 2012 |
Care Coordination and Linkages to Services and Engaging Families |
| Healthy Babies Kids and Families, Perinatal Communication Tool |
(Vermont ABCD I Project) This form was designed to promote improved care coordination between MCH coordinators, Medicaid providers, and home visiting programs–allowing for a more streamlined approach to improve access to quality services for pregnant women. |
April 2007 | Care Coordination and Linkages to Services |
| Touchpoints Implementation Survey | (Vermont ABCD I Project) This survey was used to collect data about provider and staff implementation of the Touchpoints guiding principles presented during the Touchpoints seminar. | July 2003 | Gauging Success: Measurement and Evaluation |
| Touchpoints Post-Training Assessment Form | (Vermont ABCD I Project) This post-training assessment of Touchpoints for University of Vermont faculty and other trainees was designed to determine the sustainability of the Touchpoints model. | July 2003 | Gauging Success: Measurement and Evaluation |
| Evaluation Plan for Vermont’s Healthy Babies, Kids, and Families Program |
(Judith Shaw, Annette Rexroad: Vermont ABCD I Project) This Evaluation Plan submitted as part of the Vermont Healthy Babies, Kids, and Families Expansion grant focuses primarily on documenting the processes by which Medicaid services are administered. |
May 2002 | Gauging Success: Measurement and Evaluation |
| Healthy Babies Kids and Families, Pediatric Communication Tool | Vermont ABCD I Project. This form was designed to promote improved care coordination between MCH coordinators, Medicaid providers, and home visiting programs–allowing for a more streamlined approach to improve access to quality services for Medicaid eligible children. | February 2002 | Spreading Results |
State Policy Options to Improve Delivery of Child Development Services: Strategies from the Eight ABCD States
/in Policy Reports Health Coverage and Access /by NASHPSince 2000, the National Academy for State Health Policy (NASHP) and The Commonwealth Fund have conducted two state learning consortia dedicated to improving the delivery of child development services to young children who are Medicaid beneficiaries. The work of the states involved in the Assuring Better Child Health and Development (ABCD) initiative has shown that state policies, especially Medicaid policies, can effectively promote improvements in the quality of preventive and developmental services provided to young children. This report provides a starting point for states seeking to identify and implement policy improvements to achieve two main objectives:
• improve the identification of young children with or at risk for developmental delays through promoting use of an objective, standardized screening tool; and
• improve families’ access to follow-up services, including assessment, referral, and care coordination.
The policies that govern the operation of any state program can be divided into three groups – policies that define what services the program will cover for which people (coverage), those that establish how much the program will pay for a qualified service (reimbursement), and those that establish how services will be delivered (performance). State Policy Options to Improve Delivery of Child Development Services presents specific policy improvements that emerged from efforts of the eight ABCD states that can serve as models and inspiration for states interested in improving developmental services for young children.
| ABCD_state_policy_options.pdf | 500.5 KB |
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For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
