Vermont – Medical Homes

In 2007, the legislature directed the Vermont’s Blueprint for Health (Blueprint), the state’s chronic care prevention and management plan, to launch a pilot of patient-centered medical homes (PCMHs) in the state. Three communities were selected to pilot this model, which included introducing multi-disciplinary community health teams (CHTs) to provide care coordination and support practices in achieving medical home recognition. By December 2011, Vermont succeeded in spreading its program statewide. In the 2013 Vermont Blueprint for Health Annual Report, Vermont reported that over 514,000 Vermonters – over 80% of the state’s total population –are served by recognized patient-centered medical homes.

Vermont has continued to add onto this primary care infrastructure to include multi-disciplinary teams to support specialized populations. Support and Services at Home (SASH) teams provide services to vulnerable Medicare beneficiaries launched in 2011, and Hub and Spoke teams launched in 2013 support Vermonters with opioid addiction who are being treated with Medication Assisted Therapy.

The Vermont General Assembly has demonstrated their commitment to the Blueprint and improving the health and care of all Vermonters by passing multiple pieces of landmark legislation expanding access to medical homes.

Federal Support: 

  • Vermont is one of six states selected in February 2013 by the Centers for Medicare and Medicaid Innovation (CMMI) to receive a State Innovation Model (SIM) Model Testing Award. Vermont received $45 million to implement and test its State Health Care Innovation Plan, which will expand the Medicare Shared Savings ACO model to Medicaid and commercial payers, and test episode-based payment and pay for performance models in alignment with the state’s work to advance patient-centered medical homes through the Blueprint for Health. Vermont’s work to pursue ACOs is profiled on the Vermont page of NASHP’s State Accountable Care Activity Map.
  • Vermont is one of the eight states selected to participate in the Medicare Advanced Primary Care Practice (MAPCP) demonstration program.
  • On March 4, 2014, CMS approved a Section 2703 health home state plan amendment, creating health homes for Medicaid enrollees with opioid addiction and the risk of developing an additional chronic condition in nine of the state’s 14 counties. The SPA, which became effective as of July 1, 2013, supports Vermont’s “Hub and Spoke” model in providing medication assisted treatment for people with opiate addiction. To learn more about Section 2703 Health Homes, visit the CMS Health Homes webpage.
  • Vermont has also received a duals demonstration grant from the Centers for Medicare & Medicaid Services (CMS) to “coordinate care across primary, acute, behavioral health and long-term supports and services for dual eligible individuals.

Last Updated: June 2014

Forming Partnerships
Act 71 of the 2007-2008 legislative session created an executive committee to advise the director of the Blueprint for Health. The legislation requires government, provider, private payer, quality assurance, and consumer representation. Act 128 of the 2008-2009 legislative session expanded membership to include business and home health stakeholder representation.
The executive committee was charged with engaging insurance plans, professional organizations, community and nonprofit groups, consumers, businesses, school districts, and state and local government to create a five-year strategic plan.
Defining & Recognizing a Medical Home
Definition: Act 128 of the 2009-2010 legislative session requires that medical home providers:
  1. Provide comprehensive prevention and disease screening for his or her patients and managing his or her patients’ chronic conditions by coordinating care;
  2. Enable patients to have access to personal health information through a secure medium, such as through the Internet, consistent with federal health information technology standards;
  3. Use a uniform assessment tool provided by the Blueprint in assessing a patient’s health;
  4. Collaborate with the community health teams, including by developing and implementing a comprehensive plan for participating patients;
  5. Ensure access to a patient’s medical records by the community health team members in a manner compliant with federal and state law; and
  6. Meet regularly with the community health team to ensure integration of a participating patient’s care.

Recognition: NCQA PCMH recognition

Aligning Reimbursement & Purchasing
Practices receive enhanced per-member per-month (PMPM) payments in addition to fee-for-service reimbursement. Payments vary by NCQA PCMH recognition year and score, from $1.20 to $2.39 for practices with 2008 NCQA recognition and from $1.36 to $2.39 for practices with 2011 NCQA recognition.
All payers share responsibility in funding at total of $350,000 for each Community Health Team (CHT). CHTs consist of five FTEs for every 20,000 Vermonters in the CHT’s service area.
Prior to Medicare’s direct participation under the Medicare MAPCPdemonstration, Vermont subsidized Medicare’s share of payments.
Supporting Practices
Practice support has included:
Measuring Results
The evaluation between Blueprint participants and Comparison groups, reported on in the 2013 Vermont Blueprint for Health Annual Report, released in January 2014, suggested a positive impact on clinical quality, utilization, and cost:
  • Clinical Quality: The report found that Blueprint participants experienced better clinical quality on a variety of measures relative to comparison groups (* indicates statistically significant difference for Medicaid populations):
    • Breast cancer screening
    • Cervical cancer screening*
    • Well-child visits and adolescent well-care visits
    • Diabetes care
  • Utilization: The report indicates that utilization patterns differ between Blueprint participants and comparison groups. Blueprint participants demonstrated (* indicates statistically significant difference for Medicaid populations):
    • Lower rates of all-cause inpatient hospitalizations*
    • Higher rates of primary care visits*
    • Lower rates of medical and surgical specialty visits*
    • Mixed results for emergency department utilization, with lower rates for the commercial population and higher rates for the Medicaid population
  • Cost: Relative to comparison groups, Blueprint participants had lower annual per-member health care expenditures. Relative to comparison groups, the report identifies per-person savings of $586 per commercially insured adult, $386 per commercially insured child, $447 per adult Medicaid enrollees and $200 per pediatric Medicaid enrollee.
    • Medicaid beneficiaries participating in the Blueprint also had lower per-member costs relative to comparison groups, though results were not statistically significant. The 2013 Annual Report found statistically significant reductions in outpatient and pharmacy expenditures and non-statistically significant reductions in inpatient and professional services. Medicaid beneficiaries demonstrated a significant increase in spending on Special Medicaid Services like transportation, case management, dental services, and mental health and substance abuse treatment.