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.
- Act 191 of the 2005-2006 legislative session endorsed and codified the Blueprint.
- Act 71 of the 2007-2008 legislative session further defined the Blueprint’s infrastructure and authorized the demonstration program.
- Act 204 of the 2007-2008 legislative session mandated the state’s large commercial plans (defined as a market share of 5+ percent) to participate in the demonstration program
- Act 128 of the 2009-2010 legislative session expanded the demonstration program, requiring at least two recognized medical homes in every hospital service area by July 2011 and access to all primary care practices who wish to participate by October 2013.
- 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
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:
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.
Practice support has included:
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: