Vermont Crafts Innovations in Health Care

By Peter Hirschfeld VERMONT PRESS BUREAU

SOUTH BURLINGTON – Rep. Peter Welch said Monday that Washington, D.C., can take its cue from Vermont as the nation's lawmakers seek to reduce ballooning health care costs.

With Congress set to work on a health care reform plan intended to trim $2 trillion in costs over the next decade, the Democratic congressman unveiled proposed legislation modeled after a pair of initiatives crafted in the Green Mountains.

The Blueprint for Health Act of 2009 would institute nationally a Vermont-born program aimed at better management and prevention of chronic diseases. A second bill, to be introduced in the next week or so, Welch said, would change the insurance-compensation structure so that doctors are rewarded for patient outcomes instead of the sheer volume of people they serve.

"(Vermont's) proactive efforts to increase patient satisfaction, while reducing the unsustainable cost of health care, should serve as a model for the nation," Welch said at the Aesculapius Medical Center, a South Burlington primary-care center that serves about 18,000 patients. "I look forward to bringing Vermont's innovative ideas and successful programs to Washington as Congress begins anew the health care reform debate."

The Blueprint for Health, a nascent pilot program now serving about 60,000 Vermonters, uses so-called Community Care Teams to complement the work of primary-care physicians by offering follow-up services from nurses, nutritionists, dieticians, trainers and social workers.

The relatively modest up-front personnel costs – the Aesculapius initiative costs about $400,000 annually – will mitigate the chronic diseases that consume about three-quarters of all health care expenses nationally, according to Dr. John Brumsted, chief quality officer for the Blueprint program at Fletcher Allen Health Care.

"We believe this will not only ensure better care for patients but, over time, bend the curve of rising health care costs," Brumsted said.

Dr. Jennifer Gilwee, a primary-care doctor at Aeculapius, said the seven-month-old program is already bearing results. Her 20-minute visits with patients, she said Monday, are insufficient to address the host of lifestyle changes necessary to combat and prevent chronic diseases like diabetes or high blood pressure.

The nutritionists, trainers and other experts who follow up with her patients, Gilwee said, can put in place the diets and lifestyle regimens that she alone is unable to implement.

"It's been rewarding to have so much help and so much support," said Roberta Proulx, a patient of Gilwee's who has used the Blueprint services to alter her own diet and better manage her diabetes. "I wasn't a real faithful exerciser before, but the trainer we had at the (YMCA) was just excellent – very encouraging and very helpful."

Gilwee said she's already seen improvements in lab results for many of her patients. The Blueprint program also includes an administrative support team that contacts patients when it's time for their next check-up.

"We're reaching out to patients instead of waiting for them to reach out to us," Gilwee said.

Insurance companies are participating voluntarily in the program, helping subsidize the extra costs by paying a monthly per-patient fee of between $1.40 and $2.90.

"It's almost intuitive that this is a better way to manage people's care," Brumsted said.

Welch said President Barack Obama's call to reduce trillions in health care costs in the coming years will spawn new reforms. Vermont, he said, has been on the "forefront" of a structural shift in the delivery of health care services that deserves national attention.

Though Welch supports a single-payer system, a concept that has so far earned little momentum in the new healthcare debate, he said he's concerned more about reducing costs than he is about the mechanism by which the goal is reached.

"However we get there," Welch said, "is of secondary importance to me than that we get there."