Blueprint for Health: Working Together for Better Care (1 of 3)

NARRATION Vermont’s Blueprint for Health is a state-wide
public-private initiative that seeks to provide the incentives and the infrastructure to support
the delivery of coordinated, high quality health services.
CRAIG JONES The Blueprint is hoping to achieve the Triple
Aims, and the Triple Aims really include improving the health of the population, improving control
over health care costs, and improving the patients’ experience of care.
NARRATION To accomplish these goals, the Blueprint creates
a comprehensive approach that addresses some of the most fundamental components and drivers
of healthcare.
CRAIG JONES The design principles are to have high quality
primary care for all citizens; to have the support, the multi-disciplinary type of support
that many citizens need; to really link community services with health care, to take away the
silos, and to really bridge more comprehensive health and human services.
NARRATION The first step was to make fundamental changes
to the delivery of primary care.
PAM FARNHAM Well, when you look at the primary care physician’s
schedule in a given day, they have usually a ten to fifteen minute block to see a patient.
When you’re dealing with someone with often multiple chronic diseases-- sometimes financial
issues, housing issues-- to think that you can handle that in a fifteen minute visit
is ridiculous.
LAURAL RUGGLES Prior to the Blueprint, what our doctors would
talk about was that doorknob moment, when they were just about to leave the room, they
were really afraid to say to the patient, “Is there anything else I can help you with?”
because they didn’t have the time to help and they didn’t have the resources to help.
BETH TANZMAN Primary care providers, when asked to identify
one of the gaping needs that they have, consistently talk about the need for more access to mental
health services, substance abuse treatment services, and also assistance with helping
to change the health behaviors of the patients that they see.
CHRIS HEBERT John, how are you?
CHRIS HEBERT So John came to me as a new patient. And I
remember- because this happens all the time with patients- that he says he has a “touch
of diabetes” or “may have a little sugar,” but looking back in the record it seemed that
he did have diabetes.
So at the very first visit, I drew some labs, one of which was the hemoglobin A1C. It came
back at 8.5.
JOHN Dr. Hebert was telling me, “I’m going
to have to put you on the medication called metformin, and then you might have to take
insulin, and we gotta kinda make a decision here.”
NARRATION John wanted to avoid being put on diabetes
medication, but he had never been successful at making lifestyle changes before.
JOHN That’s me with like three extra chins. I
probably weighed about 250 to 260 pounds.
I would go through spurts where I would be able to lose weight--that would be by diet
and cutting back on stuff. I’ve lost 20 pounds, and then all of a sudden, boom, in
two months that 20 pounds is back on and maybe it’s 30.
NARRATION Fortunately for John, the Blueprint model
provides doctors with access to multi-disciplinary Community Health Teams to provide the necessary
health education and supports that patients need.
EMILY PIAZZA We use three different screenings. We use
one for anxiety, one for depression, and one for alcohol use.
So when I first met with John, it became apparent that he was suffering from some depression
and was using alcohol more than a normal amount.
JOHN I hurt my back working in produce, and basically
I have three herniated disks, I have degenerative disk disease, and I am on full time disability.
EMILY We definitely talked a lot about how his depression
and how his alcohol use was affecting his nutrition, quality of life, and his diabetes.
EMILY PIAZZA So about, a piece of bread this size is what
we would consider one carbohydrate serving.
JOHN She got me involved in making the decisions
instead of just telling me “you have to do this.” Emily is always like, “Do you
think, do you think you could get yourself to the pool two days a week? Do you think
you might be able to eat wheat bread instead of white bread, which is so much better for
you?”
EMILY PIAZZA After our first meeting, John decided he was
going to start focusing on identifying his carbohydrate portions, and he also resolved
to get back into the pool at least twice a week for 20 minutes.
CHRIS HEBERT I was probably--not sure that John would make
those changes. You know he’s a middle-aged man, and hasn’t made too many changes for
most of his life. I didn’t know if he would be able to make those.
JOHN What she’s done is helped me to organize,
you know to really come up with a plan, and made it more well-rounded. It made it easier
to follow.
CHRIS HEBERT I think once he started working with the dietician
and making a few changes, he felt a lot better, too.
JOHN I think I’ve dropped somewhere between 36
and 40 pounds, I’m going to the pool on the average 6 out of 7 days a week.
JOHN I’m getting a lot of feedback, just positive
feedback about how “you look great.” I don’t feel like I’m done yet. I’d like
to lose another 20 pounds on top of the about 40 that I’ve already lost. I’m very happy.
I feel healthy.
EMILY PIAZZA And that’s what really keeps people going,
is knowing that they have the confidence and abilities to keep doing it every day.
CHRIS HEBERT Becoming involved with the Community Health
Team--the Blueprint for Health--has definitely benefited my practice over the last year that
we’ve done it, and I think it’s better for patient care.
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