Vermont Health Resource Allocation Plan HRAP Prepared for Vermont Health Care Summit Advancing Workf

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VermontHealth Resource Allocation Plan
(HRAP)Prepared for Vermont Health Care Summit
Advancing Workforce Economic Solutions Stowe,
Vermont June 2, 2005byPaulette Thabault,
Deputy CommissionerVermont Department of
Banking, Securities, Insurance and Health Care
Administration
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Act 53 Statutory Background of the HRAP

• Purpose of Act 53 - passed by Vermont
  Legislature in 2003
• Strengthen the health planning process.
• Assist consumers in making decisions by providing
  accessible, useful information comparing cost and
  performance.
• Develop a health resource allocation plan to
  guide health facility planning, capital
  expenditures, and budget reviews.
• Create efficient and effective regulatory system
  capable of achieving Vermonts health care cost
  containment and other health care policy goals.
• Open dialogue between hospitals and their
  communities.
• Increase opportunities for public involvement in
  health policy planning.

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Act 53 Statutory Background of the HRAP

• HRAP Requirements under Act 53
• Commissioner of Vermont Division of Banking,
  Insurance, Securities and Health Care
  Administration (BISHCA) to prepare a four-year
  Health Resource Allocation Plan (HRAP) to
  submitted to the Governor on or before July 1,
  2005.
• Each hospital must conduct four-year community
  needs assessments to identify and prioritize the
  health care needs of the community, and publish
  hospital community reports, which include
  measures of
• Quality
• Patient Safety
• Financial Health
• Costs

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Conceptual Framework of the HRAP

• The HRAP must
• Identify Vermont needs regarding health care
  services, programs and facilities.
• Identify the resources available to meet
  identified needs.
• Identify the priorities for addressing needs on a
  statewide basis.
• The HRAP includes
• Statement of Principles
• Current supply and distribution of services
• Recommendation for appropriate supply and
  distribution of services, including
  implementation options
• Benchmarks wherever possible
• Specific Health Services Addressed by the HRAP

Hospital Services Nursing Home Services
Home Health Services Mental Health Services
Substance Abuse Services Emergency Care
Ambulatory Care Major Medical Equipment
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Conceptual Framework of the HRAP

• The Commissioner of BISHCA established the HRAP
  Advisory Committee with diverse perspectives on
  health care to review drafts and provide
  recommendations during development.
• Current Members
• Health Care Professionals
• J. Churchill Hindes - CEO, VNA of Chittenden
  Grand Isle Counties
• David Little, M.D. - Medical Director, UVM AHEC
  Program
• Stephen Marion - Vice President, Regional
  Planning, Dartmouth-Hitchcock Alliance
• Madeleine Mongan - Vice President, Policy,
  Vermont Medical Society
• Betty Rambur, DNSc, R.N. - Dean, Professor, UVM
  College of Nursing Health Sciences
• David Reynolds - Executive Director, Northern
  Counties Health Care
• Harvey Yorke - President CEO, Southwestern
  Vermont Health Care

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Conceptual Framework of the HRAP

• Current Members (cont.)
• Consumer Representatives
• John Nopper - Owner, River View Farm
• Patricia Burnham - Consultant, Transitions
  Associates
• Public Oversight Commission
• Greg Peters - Managing Partner, Lake Champlain
  Capital Management, LLC
• John O'Kane - Manager, Community Government
  Relations, IBM Corporation
• Health Care Payer
• Michael McCormack, CPA - McCormack, Guyette
  Associates
• Third Party Payer
• Catherine Hamilton, Ph.D - Vice President,
  Planning, BCBSVT

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Guiding Principles of the HRAP

• In accordance with the established principles,
  the Vermont Health Care System will be
• Safe by identifying strategies and implementing
  mechanisms to avoid injuries to patients from the
  care that is intended to help them and to
  provider staff from the environment that is
  intended to support them.
• Effective by identifying strategies and
  implementing mechanisms to provide services based
  on scientific knowledge to all who could benefit
  and refraining from providing services to those
  not likely to benefit.
• Patient Centered by identifying strategies and
  implementing mechanisms for provision of care
  that is respectful of and responsive to
  individual patient preferences, needs, and values
  and for ensuring that patient values guide all
  clinical decisions.
• Timely by identifying strategies and implementing
  mechanisms to promote appropriate waits and avoid
  harmful delays for both those who receive and
  those who give care.
• Efficient by identifying strategies and
  implementing mechanisms to avoid waste, in
  particular waste of equipment, supplies, ideas,
  energy and money.
• Equitable by identifying strategies and
  implementing mechanisms to provide care that does
  not vary in quality because of personal
  characteristics that are not in the control of
  individuals such as gender, ethnicity, geographic
  location, and socioeconomic status.
• Each principle is further developed in the HRAP
  through a series of sub-principles.

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Key Chapter Information

• Chapter 1 Inpatient, Emergency, and
  Hospital-Based Services
• Chapter 2 Ambulatory Care Services
• Chapter 3 Community-Based Services
• Chapter 4 Other Medical Services
• Chapter 5 Healthcare Workforce
• Chapter 6 Healthcare Information Technology
• Chapter 7 Certificate of Need Standards

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Chapter 5 Quick Facts Healthcare Workforce

• Healthcare Workforce Quick Facts
• Vermont experienced a net increase of 85
  physicians (43 primary care physicians and 42
  specialists) between 2000 and 2002.
• More than one-fourth of the 1,565 physicians
  licensed to practice medicine in Vermont provide
  less than 30 patient-care hours per week.
• Maldistributions exist for the supply of both
  nurse practitioner and physician assistant
  midlevel practitioners across the state on both
  FTE and population-based measures.
• Advance practice registered nurses include nurse
  practitioners, nurse midwives, nurse
  anesthetists. Nurse midwives and psychiatric
  nurse practitioners are in short supply in
  several Vermont HSAs a disproportionate portion
  of FTEs in these disciplines work in the
  Burlington area.
• Reflecting national nursing shortages, forecasts
  indicate the supply of nursing professionals will
  not meet Vermonters needs after 2011.
  Furthermore, nursing professions experience high
  vacancy and turnover rates, particularly in home-
  and long-term care.
• Thirteen Vermont counties have been designated
  Medically Underserved Areas by the Federal
  government Addison, Caledonia, Chittenden,
  Essex. Franklin, Grand Isle, Lamoille, Orange,
  Orleans, Rutland, Washington, Windham and Windsor.

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Workforce Priorities

• Primary care access, particularly for Medicaid
  population
• Nursing shortages
• Aging workforce
• Faculty shortages
• Long-term care shortages
• Advance practice nurse shortages
• Personal care worker shortages
• Mental Health
• psychiatry, especially adolescent
• mental health/substance abuse
• Dental workforce, particularly for low income
  populations

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HRAP Recommendations on Workforce

• Target maldistribution of workforce, particularly
  primary care
• Recruitment programs such as loan repayment
• Career ladder development
• Job re-design enabling older nurses to remain in
  jobs longer
• Faculty education initiatives
• Develop standards for optimum mix of providers,
  particularly in primary care