Is Clinical Care Becoming More Coordinated and Integrated?

Yes! There are a number of initiatives in motion within Vermont that are bringing hospitals, physician practices, and key community partners together to improve our care delivery system and make it more coordinated and integrated. Through accountable care organizations (ACO’s) and the Vermont Blueprint for Health, providers are working more closely together than ever before and the result is measurably improved care for our patients!

NMC is a member of two of the three ACO’s within Vermont: OneCare Vermont that was created by Dartmouth and the UVM Medical Center; and CHAC (Community Health Accountable Care) created by nine Federally Qualified Health Centers (FQHC’s) around the state, including NOTCH (Northern Tier Centers for Health) which serves Franklin and Grand Isle counties. The ACOs are part of a national effort to transition healthcare from “fee for service” (where providers get paid for each procedure or visit) to “population health” (where providers are paid to keep populations healthy).

Making this happen in our community will require significant collaboration, alignment of clinical approaches around evidence-based best practices, and data measurement. Here in our area, the Regional Clinical Performance Council (RCPC) provides the forum for that integrative work. This council is made up of key representatives from NMC, Vermont Department of Health, Northwestern Counseling & Support Services, Franklin County Home Health, long term care, physician practices, and other community partners. Based on the data regarding opportunities for improvement, our local council is focused on four key areas: Emergency Department utilization, Hospice utilization, At-Risk Population care pathways, and preventative care screenings. Teams are in place to address each of these four areas of priority. In addition to the teamwork, there is a series of “Learning Collaboratives” which link the efforts of the RCPC and the established work of the Vermont Blueprint for Health, providing a forum for education and collaboration on key topics. The Leadership Collaboratives kicked off in May with about 70 individuals from local physician practices and community partners in attendance. It was an extraordinary day with great participation and energy. Northwestern Vermont continues to show great collaboration among the many entities that collectively serve our community. That is an essential building block for the transition from fee for service to population health. Meanwhile, CHAC has completed the work on four clinical pathways to define best practice. Their work is focused on Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), Diabetes, and Falls and will be presented to the Regional Clinical Performance Council. Consistent practice across all the ACOs is the goal as it represents an evidence-based, best practice path to achieving the greatest clinical impact.

It is exciting to see that clinical impact already occurring and evident in the measurement of the quality of care in our community.  The Centers for Medicare & Medicaid conduct annual quality audits on care metrics. In the most recent audit, overall statewide performance in OneCareVT showed a 5% performance increase for all Accountable Care Organization covered patients. That’s good news for all Vermonters. It is particularly good news in our region, as our Health Service Area improved 28% in overall performance! That is the highest increase among all the regions in the State and our area now exceeds the OneCareVT overall average! We have already achieved significant improvement in six of the nine preventative screening measures, which is so important in efforts to early detection and reducing costly treatment interventions needed once conditions have spiraled. It is so encouraging to see improvement in rates of screening mammography. Moving forward, we need to continue to build on that success and strengthen our rates of colorectal cancer screening, and blood pressure screening, while continuing to improve mammography participation. Please speak to your primary care provider about what screenings are right for you as we need your help in achieving the wellness goals

This measureable improvement is clear evidence of the benefit of clinical coordination between hospitals, physicians, key partners, and members of our community. Our strong performance locally – leading the State in improvement – is a testament to the level of engagement we have seen here in our community. The results are inspiring. They show that through collaboration and coordination and integrated clinical approaches, we can improve population health.

We are definitely more than a hospital; we are actively coordinating and partnering on health efforts across our community to better serve you.

— Jill Berry Bowen, NMC’s Chief Executive Officer