The Blueprint framework includes incentives and mechanisms for practices and CHTs to monitor and improve quality on an ongoing basis, and for the state to conduct system-level evaluations.
Encouraging evidence-based care and continuous quality-improvement. The chief way in which Vermont has encouraged evidence-based care is by expanding NCQA-PCMH certification statewide. Practices must be able to measure and improve performance to achieve PCMH recognition and receive quality payments. Linking payments on a sliding scale to NCQA scores incentivizes high performance. Blueprint supports for providers, including EQuIP practice facilitators, learning collaboratives, and the central clinical registry, create capacity within a practice to meet this PCMH standard. In addition, a Blueprint staff member reported that Blueprint is facilitating quality-improvements in two ways: (1) by generating a series of "practice profiles" based on an all-payer insurance claims database, to help practices benchmark their health care utilizations, use of preventive health care screenings, other care practices, and costs; and (2) by conducting annual reviews of clinical charts focused on key issues, such as the degree to which recommended diabetes care is being implemented, or whether patient self-management plans are present and followed up on.
Evaluation strategies. Evaluation strategies include examining the following performance categories: health care expenditures, health care utilization, the quality of health services, patient health outcomes, and patient experience of care. According to Blueprint staff, Vermont is preparing to assess the extent to which the health of the population is improving (for example, "Have hospitalization rates decreased?"), costs have declined, and patients are using preventive care and engaging in self-management workshops. Furthermore, the state hopes to understand the relationship between performance measures, such as the relationship between NCQA scores, patient participation in Blueprint initiatives, health care utilization patterns, and costs. Vermont has been systematically building data sources to form queryable databases so state staff and others can mine them for evaluation. Performance measures will derive from an all-payer claims database, the central clinical registry, the NCQA scoring database, and NCQA's PCMH patient experience survey (Table VI.3).
|TABLE VI.3. Vermont Data Sources and Performance Measures Available for Evaluation|
|Data Sources||Performance Measures|
| Health Care
| Health Care
| Patient Experience
|All-payer claims database||X||X||X|
|Central clinical registry||X||X|
|NCQA-PCMH scoring database||X|
|NCQA-PCMH patient experience survey||X|
|SOURCE: Adapted from DVHA 2013b.
NOTE: The claims database will provide HEDIS measures. Health outcomes used for initial evaluations in the 2012 annual report include rate of hospitalizations, rate of emergency room visits, and prevalence of diabetes indicators.