MIDDLEBURY — Porter Medical Center leaders said they are “all-in” on a major shift in the way health care is delivered in the state, a shift designed to cure patients in a cheaper, more effective and more holistic way.
It’s called the “Vermont Blueprint for Health,” a state-led, nationally-recognized initiative that is helping health care providers meet the medical and social needs of people in their communities. All of the Blueprint work is closely integrated with health and human service organizations throughout Addison County that guide care delivery and payment reforms at the local level.
According to the Vermont Department of Health, the Blueprint’s overarching goals are to produce better health care services, a healthier population, and better control over medical care costs. In short, it means the county’s providers are doing more talking amongst themselves — and particularly with patients — to make sure their needs are better met in doctors’ offices, the hospital, the local nursing home, and/or in their homes when they are recovering from major procedures.
Any primary care practice that wants to become a “patient-centered medical home practice” can qualify for Blueprint membership and thus qualify for funding to hire a support team such as Porter’s. A combined total of 129 primary care practices spread through all 14 of the state’s medical service areas are currently participating.
“Historically, hospitals wait for patients to come to us when they’re sick or injured,” PMC spokesman Ron Hallman said. “We bandage them up and send them on their way and then they’re on their own. I think we are now entering a world where we going to be responsible for more than that. We are going to be interested in, ‘Does this person need food?’; does this person have mental health, housing and do they have all of the services they need in a comprehensive way to really treat the whole person and keep them well, versus just bandaging them up and sending them home.”
To that end, PMC has assembled a team of “Blueprint” professionals to implement these new goals. These folks and their services are made possible through a combined total of approximately $900,000 in annual Blueprint funding from a combination of state grants, federal Medicaid and Medicare payments, and private insurance funds.
Susan Bruce is manager of PMC’s Blueprint Project for the Middlebury health service area. She oversees PMC’s Blueprint funding and presides over Porter’s Blueprint staff and its Community Health Team.
“It is the side of Porter that has been working behind the scenes to get ready for the current and future of health care, in terms of not just taking care for people when they come here sick, but thinking about population management and chronic care and all kinds of ways we coordinate and manage care and work with others,” Hallman said of the organization’s Blueprint efforts.
“It is a side of Porter that I think is really important,” he added. “We have a very robust team of really smart people working on it.”
It was in 2012 that PMC created its “Community Health Team,” led by Cathy Swearingen. The Community Health Team, among other things, is expanding current services to include free care coordination, counseling, substance abuse treatment support and health coaching, according to Dr. Carrie Wulfman, PMC’s chief medical officer and an Addison County family doctor for the past 18 years.
Porter also created a Case Management Department six months ago under the leadership of Alison Wurst, APRN.
“These are two efforts dealing with population health reform in our community,” Wulfman said. “We collaborate a lot, but there are two arms to this (the Community Health Team and Case Management). Both fall under the umbrella of payment reform and health care reform at both the state and national levels, she noted.
“This is the future of medicine, and this is the future of health care,” Wulfman said of PMC’s Blueprint efforts. “We want our community to know we are aware of this, and working on it. We can do a lot more things for our patients, now.”
Swearingen said the Community Health Team is embedded within eight PMC primary care practices. She oversees those care coordinators, dieticians and social workers in the Middlebury health service area. The care coordinators help folks overcome any barriers they might encounter in accessing medical services and/or achieving their health goals.
“One of the main issues this effort is trying to address is that we have many great organizations in this community, but haven’t historically been great at ‘hand-offs,’ — patients going from us to another agency,” Hallman explained. “Sometimes, that hand-off is daunting for an individual patient.”
So the Community Health Team’s goal is to help make that hand-off, so the patient can seamlessly go to the next place they need care. “If you’re going to have an integrated system, it has to be truly integrated,” Hallman said. “You can’t have 17 independent organizations that don’t talk to each other, or don’t understand each other.”
Wurst is director of Porter Case Management, as well as nurse practitioner in the hospital’s Emergency Department. She and her colleagues track patients as they move through the health care system, helping them with various transitions as they leave the hospital and seek other services.
“I’m working to help them smoothly move toward wherever else they need to go for their health,” Wurst said. “ I like to view case management as sort of the ‘web’ that exists between all these different setting of health care. It’s very critical for people in achieving their health goals and their life goals.”
Those different health care settings might include Helen Porter Healthcare and Rehabilitation, the Counseling Service of Addison County and/or Elderly Services, Inc. It all depends on the patients’ needs.
“Patients are responding very well to finally being seen as the experts in their own care, and being the ones able to direct their care,” Wurst said. “And providers are also finding that they have less of a burden, because it’s not just one more pill that’s going to fix them. It’s really looking at how the whole community is going to be able to help that provider achieve their goal of diabetes control or other medical conditions. It’s taken a little pressure off the provider offices; they know they don’t have to try to fix the world. We have a really good team that can do all of that.”
Alexandra Jasinowski is PMC’s Blueprint Quality Improvement facilitator for the Middlebury area. She provides support to primary care practices, helping them to — among other things — wade through the litany of new rules and standards outlined in the state and federal health care reform plans. She provides the same kind of health in the community, assisting all community agencies, including CSAC, the Parent-Child Center of Addison County and Addison County Home Health & Hospice.
“One of the things we are focusing on is coordinating care, approaching it in a systematic way instead of just looking at individual cases,” Jasinowski said. “We’re really trying to re-design workflow at the community level and bring it down to each organization.”
Dr. Fred Kniffin, president of PMC, is pleased with the impact the Blueprint work has been having on patient care in Addison County.
“We have been doing this work for a number of years, and doing it simply because it’s the right thing to do,” Kniffin said. “I have viewed what we’ve been doing the past few years as building the infrastructure, doing the right thing, getting ready for the future. The future is coming, and payment reform is driving that. So now we have this infrastructure built, we have great services for our community, and we are about to put it on steroids. All of a sudden it will be the right thing to do, but it will also make us money, instead of lose us money.”
The efforts are paying dividends, according to PMC officials.
Addison County is now ranked the second healthiest county in Vermont. And Vermont consistently ranks as one of the healthiest states in the union.
Porter Hospital was recently recognized by the National Organization of State Offices of Rural Health (NOSORH) as one of two Vermont hospitals with a rating of “Excellence in Quality.” And Helen Porter nursing home last spring earned a prestigious CMS 5-Star Quality rating.
It seems like the only thing certain about the health care industry these days is that it will continue to change, and local officials want to make sure the PMC remains a part of that evolution.
“The reality is that people respond to where the resources are,” Hallman said. “We are still primarily in a world where people get paid for ‘sick care,’ for volume. So keeping people healthy out of the hospital and managing their care is still something we’re learning to do… It is the wave of the future, but payment reform hasn’t quite caught up with the care reform that we’re doing. So it’s the classic situation where we still have one foot in one canoe and one foot on the dock, and we’re trying to live in both worlds at the same time.”
Nonetheless, Hallman said of the Blueprint program, “this is an investment in the future.”
Reporter John Flowers is at [email protected].