1. Health Reform and the Delivery System NASHP’s 23 rd Annual State Health Policy Conference New Orleans, LA October 6, 2010 Dulsky Watkins Lisa Dulsky Watkins, MD Associate Director, Vermont Blueprint for Health

6. Dulsky Watkins The Vermont Accountable Care Organization Pilot: A Community Health System to Control Total Medical Costs and Improve Population Health May 14, 2010 Authors: Jim Hester, Ph.D., Julie Lewis, and Aaron McKethan, Ph.D. Contact: Jim Hester, Ph.D., Director, Health Care Reform Commission, Vermont State Legislature, [email_address] Editor: Laurie Larson

8. Dulsky Watkins Blueprint Registry (web-based and centralized)

9. Dulsky Watkins Multi Payer Claims Data Base 10/06/10 Expenditure Category TOTAL Hospital Inpatient (billed by hospital) prioritization used to assign by category Mental/Substance Inpatient (ICD 290-316=HEDIS) Private Psych Hospital Other Hospitals Maternity-related and newborns Surgical (non maternity, non-mental/substance) Medical (non maternity, non-mental/substance) Hospital Outpatient (billed by hospital) Prioritization Used to assign all services during that visit to that category Mental/Substance Hospital Outpatient Observation Bed Emergency Room Outpatient Surgery Outpatient Radiology Outpatient Lab Hospital-Dispensed Pharmacy Outpatient Physical Therapy Outpatient Other Therapy Other Outpatient Hospital Non-Mental Health Professional Services Physician Services Physician Inpatient Setting (site=21) Physician Outpatient Hospital Setting (site=22) Physician Office Setting (site=11) Physician Other Setting Other Professional Services Nurse Practitioners or Physician Assistants Physical Therapists Chiropractors Podiatrists Other Non-Hospital Mental Health Professional Services Psychiatrists Psychologists Social Workers including (MSWs, LICSW, LCSW) Mental Health Clinics Other Pharmacy Pharmacy in pharmacy file Pharmacy in medical claims All Other Services Free-standing Ambulatory Surgery Center Free-standing laboratory Independent radiology services Nursing Home Home Based Care (Home Health Agency) Durable Medical Equipment Other

10. Dulsky Watkins Community Health Team Referral and Communication Flow Chart Behavioral Health Specialist Chronic Care Coordinator Community Connections VT Department of Health Community Care Managers (Medicaid, AAA, Umbrella, etc.) Physicians Nurse Practitioners Physician Assistants COMMUNITY HEALTH TEAM PRIMARY CARE OFFICE