Many provisions of the ACA hold promise for public health agencies. The reorganization of the healthcare system in the wake of health reform also poses challenges for the public health system. This session will address how public health agency roles may change, opportunities to use public health agencies to lower health costs and improve health outcomes, and the integration of categorical funding streams to build a comprehensive public health system in a post-health reform world.

1. Leveraging Public Health Capacity to Improve Health System Efficiency Wendy Davis, MD – Commissioner October 5, 2010

10. Health Disparities Report 2010

13. Insurers Providers Health IT Public Health Hospitals Benefits Managers Contracted Services Pharmaceutical Companies Vermont Blueprint History: The Bad News!

14. Health Care Reform Goals Increase Access Improve Quality Contain Costs 60+ Initiatives

16. Bennington Burlington St. Johnsbury Barre Windsor Springfield April 2007 Blueprint History 2008 - Integrated Medical Home Pilots ( all chronic conditions + prevention) 2005—Initial two pilot Hospital Service Areas (Diabetes Focus) Healthier Living Workshops Community Physical Activity Grants 2004—Planning 2003—Launch of the Blueprint 2006—Four new Hospital Service Areas (Diabetes Focus) 2006—Statutory Endorsement 2007— Medical Home Integrated Pilots in Statute

17. Improved Outcomes-Healthier People Productive Interactions Self- Management Support Delivery System Design Decision Support Clinical Information Systems Health System Health Care Organization Community Resources and Policies Public Health Policies, Systems, Environment Supportive Environment Informed, Activated Patient Prepared, Proactive Practice Team Adapted from the chronic care model which is used by permission of “ Effective Clinical Practice.” What is the Blueprint?

22. Health IT Framework Global Information Framework Evaluation Framework Operations PCMH PCMH PCMH PCMH Hospitals Public Health Prevention Community Health Team Nurse Coordinator Social Workers Dieticians Community Health Workers OVHA Care Coordinators Public Health Prevention Specialist Behavioral Health & Substance Abuse Services Blueprint Integrated Pilots Coordinated Health System Prevention Programs Policies and Systems Local, state, and federal policies and laws, economic and cultural influences, media Community Physical, social and cultural environment Organizations Schools, worksites, faith-based organizations, etc Relationships Family, peers, social networks, associations Individual Knowledge, attitudes, beliefs

26. Health IT Framework Global Information Framework Evaluation Framework Operations PCMH PCMH PCMH PCMH Hospitals Public Health Prevention Community Health Team Nurse Coordinator Social Workers Dieticians Community Health Workers OVHA Care Coordinators Public Health Prevention Specialist Behavioral Health & Substance Abuse Services Blueprint Integrated Pilots Prevention Tobacco Cessation Community messaging & education, facilitate linkages and broad access to cessation programs Coordinated referrals & patient support between PCMHs + CHTs + Tobacco Cessation Services (phone based counselors, community based group programs) Expand counseling capacity by training behavioral health counselors and social workers on CHTs. Trained counselors as part of the CHT who can broadly support enhanced self management. DocSite clinical tracking & reporting that supports outreach by Tobacco Cessation Counselors and coordination between care delivery and cessation programs VDH Surveillance generates population indicators re prevalence, risk behaviors & exposures, co-morbidities, healthcare utilization & costs. Supports policy making, planning for care delivery and public health strategies, quality improvement, and tracking of program impacts. Policies and Systems Community Organizations Relationships Individuals

28. St. Johnsbury Family HC Chronic Care Coor .5 FTE Beh. Health Spec. .5 FTE Concord Health Ctr. Chronic Care Cood .5 FTE Beh. Health Spec. .5 FTE Danville Health Center Chronic Care Coor .5 FTE Beh. Health Spec .5 FTE Corner Medical Chronic Care Coor 1 FTE Beh. Health Spec 1 FTE Other DVHA Care Managers Hospital Care Managers Hospital-based CC Educators Community-based Advocates Community Connections Community Health Workers CC Comm. Health Worker VDH District Office Public Health Specialist Ladies First Coordinator Calodenia Int. Medicine Chronic Care Cood .5 FTE Beh. Health Spec. .5 FTE St. Johnsbury Community Health Team Care Integration Coordinator 1 FTE

30. Pilot Locations thru July 2010

31. Blueprint Integrated Health System - Proposed Expansion 10/05/10 July 2008 Jan 2009 July 2009 Jan 2010 July 2010 Jan 2011 July 2011 Jan 2012 July 2012 Jan 2013 July 2013 Pilot # 1 St Johnsbury HSA St Johnsbury HSA Expansion Pilot # 2 Burlington HSA Burlington HSA Expansion Readiness Pilot # 3 Barre HSA Barre HSA Expansion Readiness HSA # 4 Rollout Readiness HSA # 5 Rollout Readiness HSA # 6 Rollout Readiness HSA # 7 Rollout Readiness HSA # 8 Rollout Readiness HSA # 9 Rollout Readiness HSA # 10 Rollout Readiness HSA # 11 Rollout Readiness HSA # 12 Rollout Readiness HSA # 13 Rollout Implementation Phase Demonstration Phase (Medicare?) Target Population % of VT Population # CHTs 42,179 6.7% 2 126,286 20% 6 316,662 50% 16 508,17 80% 25 637,130 100% 32

34. Even silos can be systematic!

35. QUESTIONS??? Web address: www.healthvermont.gov