Health Care Reform Update from VNA President and CEO Judy Peterson

The phrase “health care reform” has been widely used for years to broadly describe changes in the way we receive and pay for health care. Yet, many of us still have a difficult time truly understanding what it all means and how it impacts us as health care consumers. As the CEO and President of your VNA, I have been at the table representing community-based health care and participating in the exploration and implementation of new ways to organize, deliver, and pay for health care services for Vermonters.

At a state level, our work is guided by the national goals of health care reform that focuses on three objectives – improving health care quality, improving patient satisfaction and reducing the cost of health care – referred to as the Triple Aim. Home health is uniquely positioned to deliver outcomes on all three of these goals, making this both an exciting and challenging time for the VNA. The VNA also recognizes what we call the Quadruple Aim, which includes providing support and training to our dedicated staff, without whom, we could not serve our community.

I would like to share an update with you on how your VNA is engaging in Vermont’s health care reform initiatives and working to improve the health of our community.

Central to many of the ideas behind health care reform efforts is a growing appreciation for social determinants of health; the conditions in which people are born, grow, live, work and age that are now recognized as key drivers of health. For someone unable to afford or access healthy food or who lacks permanent housing, managing their health condition becomes a secondary concern, until their condition worsens to the point of requiring an emergency department visit.

The home health industry and your VNA, a Medicare-certified home health and hospice organization, have recognized this connection for many years. The VNA is a care provider that delivers services to our community members wherever they call home. We are able to identify the many factors that affect people’s health and build trusting relationships to help them heal faster and more completely. VNA staff also teaches them how to manage their disease or condition. Our goal is to empower people to live the healthiest lives they can, to reach their fullest health potential, or to die with dignity and comfort in a supportive and caring environment.

As an active participant in health care reform efforts, the VNA is a member of the Vermont Care Organization (VCO) which is a group of health care providers that includes doctors, hospitals, home health agencies and other health care providers. We have all voluntarily come together to provide coordinated, high-quality care to people in our communities. The goal of the VCO is to help people – especially the chronically ill – get the right care, at the right time, and in the right setting, which results in better health outcomes at a lower cost.

In recent years, much has been learned about how to provide better care and support for persons living with chronic disease or serious illness. From this improved understanding, our focus is turning toward creative ways to deliver care, new payment approaches that reward improved health results, and expanion of the healthcare workforce. Let me share a few examples of how your VNA is actively engaged in reforming health care.

Implementing New Care Models

Current home health eligibility criteria can limit the length of time an individual receives care in the home resulting in a discharge from home health services while the person could still benefit from ongoing care oversight. The consequence for patients with cardiac and lung disease is they are often readmitted to the hospital within weeks or months after their discharge from VNA services. To address this, VNA’s Quality and Home Health teams are piloting a Longitudinal Care Model, with support from a $46,000 grant from the UVM Community Health Investment Fund. This care model provides ongoing support and assessment to our most frail and/or complex patients after VNA visiting services end offering health coaching, medication oversight, and telemonitoring. This ongoing contact and support has significantly reduced hospitalizations and Emergency Department visits among persons in the program.

Building Capacity for Healthcare Delivery

As our population ages, we are facing a shortage in the number of people who are available and/or trained to provide care to those who need it most. VNA is working in conjunction with the University of Vermont and One Care Vermont (OCV) to train a new kind of health care provider – Community Health Workers. The Community Health Worker can provide ongoing health coaching and emotional and social support which are crucial to helping people with chronic illness manage their disease.

The VNA is also expanding its Telemonitor Program that virtually monitors blood pressure, heart rate, oxygen levels and weight through an iPad-like device. One nurse can effectively oversee an average of 70 patients daily and can quickly catch changes in their condition. This technology expands the capacity of our staff and avoids preventable Emergency Room visits and hospitalizations.

The most visible example of our ability to meet growing needs is the opening of our expanded residential hospice home, which opened in September 2016.  The McClure Miller VNA Respite House is the only Medicare-certified inpatient hospice home in Vermont which can care for up to 21 residents, an increase from the original 13 room Vermont Respite House. Since opening, we’ve continually averaged above the previous resident capacity demonstrating the need for additional inpatient hospice care.

Expanding access to data

A key principle of improving quality of care is better coordination and integration of the care patients receive from multiple providers. With the help of a grant from the Vermont Health Care Innovation Project, the VNA has connected our telemonitoring system to patients electronic health records (EHR) as well as with the Vermont Health Information Exchange, a secure network that gives health care providers the ability to electronically exchange and access patient data. This means the data collected at the patient’s home is immediately available to the home health team as well as other treating providers with the patient’s permission. This gives a primary care physician accurate and timely information about your health condition even if you haven’t seen them in several weeks.

Managers, staff and Board members of the VNA, recognize improvements in population health require working across many organizations. We continue to develop and cultivate essential relationships with our community partners including the UVM Health Network, UVM Medical Center, primary care offices, the Howard Center, Age Well, The Community Health Center, Cathedral Square Housing Corporation, area nursing homes, other home health agencies and many other providers. We believe better coordination among providers and further integration of our services are necessary to support the health and well-being of our population.

Statewide health care payment and delivery system reforms in Vermont such as Medicare, Medicaid and commercial Shared Savings Programs and now, in 2017, a Medicaid Next Generation program, are demonstrating their ability to help slow the growth of health care expenditures and improve health care delivery. In 2018, Vermont plans to launch an All Payer Model of health care payment and delivery. The VNA is and will continue to be an active participant in working with our partners in these programs to improve the health of our community.