New Study of Vermont Blueprint Reveals Improvement in Costs, Utilization, and Quality

An important new study published in the national journal Population Health Management evaluates the Vermont Blueprint for Health’s overall progress in guiding sustainable statewide healthcare delivery reform. The Blueprint, a program recognized for its advances in primary care and systemic healthcare transformation, is an innovative model that connects patients’ multiple healthcare providers. These connections, enhanced by community health teams - multidisciplinary teams bridging the medical and non-medical divide - allow better coordinated care while also empowering patients through education and prevention programs. This six-year study, co-authored by Blueprint and Onpoint analysts, demonstrated that patients who received the majority of their primary care in the Blueprint’s medical home setting had better expenditure, utilization, and quality outcomes compared to non-Blueprint patients.

The study reviewed annual outcomes from 2008 through 2013 for Blueprint participants versus a comparison population using Vermont’s all-payer claims database, the Vermont Health Care Uniform Reporting and Evaluation System (VHCURES). To evaluate the Blueprint’s impact by finding the points at which outcomes began to diverge between participant and comparison populations, the study’s sample was clustered: Participants were grouped according to when their practices joined the Blueprint, implemented the necessary steps to become certified medical homes, and matured their operations for two years, while the comparison group was randomly assigned to these programmatic stage groups and weighted to match the proportion of participants from each calendar year.

Outcomes included expenditures across all health plans, utilization (e.g., total inpatient discharges, outpatient emergency department visits, specialist visits), relative resource use through an application of the HealthPartners’ Total Care Relative Resources Values (TCRRVs), and quality of care represented by delivery of effective and appropriate care based on nationally recognized standards from the National Committee for Quality Assurance such as breast cancer screening, cervical cancer screening, comprehensive diabetes care, and appropriate pediatric care for sore throats and common colds.

Overall, the study revealed that Blueprint patients tended to fare better than non-Blueprint patients across expenditure, utilization, and quality outcomes, with the differences becoming evident as practices matured in the transformation processes fundamental to a patient-centered medical home (PCMH) model. Further drill-down by the authors found that “the difference in medical expenditures was driven by several factors, including lower hospitalization rates and outpatient facility use [for Blueprint practices]” and that, “based on an annualized cost-gain ratio, medical expenditures decreased by approximately $5.8 million for every $1 million spent on the Blueprint initiative.”

While these findings are promising for the Blueprint program and the coordinated statewide health services model that Vermont has adopted, the study’s authors highlight the importance of providing participating PCMH practices enough time and resources to deepen and refine their methods of delivering advanced primary care and to sufficiently collect and use the data derived from their programs, noting that the outcome differences between the participating and comparison populations occurred steadily as the Blueprint practices matured. The study suggests that effective multi-payer, primary care delivery transformation is a gradual process.