Introduction
In January 1996, Governor Dean challenged a group of Vermont hospital CEO's to take the lead in helping to chart the future course for health care in the State. In accepting this challenge, the Chair of the Vermont Association of Hospitals and Health Systems invited a group of state government and hospital officials to meet, with the purpose of creating an initial road map to health care in the 21st century. The pages which follow are a summation of the thinking of this group over the past year.
These documents are meant to be the starting point for a much broader statewide discussion of the future course for health care. It is recognized that the results of such discussions may lead to a very different set of Vision and Principles. As the discussions begin, however, the members of the group which authored this work believe there are only two irrefutable points:
1. A common Vision and a set of Principles for the future of health care in Vermont are absolutely necessary.
2. The final Vision and Principles must be widely supported by the people of Vermont.
Vision Statement for
An Integrated System of Health for VermontersAn Integrated System: Federal, State, and community partnerships which develop locally accountable systems of physical, mental and social health services focused on maximizing the potential of each citizen within a defined geographic area. All health services will be integrated with other economic, educational and community systems to achieve optimal results.
PRINCIPLES FOR PHYSICAL, MENTAL, AND SOCIAL HEALTH SERVICES
1. Every Vermonter has the ability to receive the physical, mental, and social health services necessary to maximize his or her potential, within available resources. These services include: education, preventive health, acute care for physical and mental health, chronic care, social services and economic development.
2. Natural service or market areas of the population define the geographic areas for purposes of integration of all physical, mental, and social health services. Integration of these services within a region is more important than coalescing around statewide programs.
3. Resources at the local level are integrated to offer each citizen a full spectrum of preventive, treatment and long term care health services, in coordination with other human services.
4. All stakeholders who are willing to work within this broad set of principles are given the opportunity to be involved in the planning and development of physical, mental, and social services at the local level. Each community will develop a unique arrangement of services, over time, based on the needs, interests, and resources of the population of the area.
5. All the physical, mental and social health service resources available in an area will be focused on improving the health status of the population. Mechanisms will be developed to deploy and redirect resources to optimize the efficient and effective use of services by the population. Any savings achieved through such initiatives will remain available to the citizens of the area to enhance other services, or create new ones.
6. A comprehensive information system at the local level is essential to create and direct network development, to assess the health status of the population, and to efficiently and effectively manage patients through the continuum of care. Each citizen, however, will be empowered to control the use of his or her individual data to the maximum extent possible, consistent with a seamless system of care. It is essential that consumer education regarding health data and information be widely available.
7. The overall health of the population of a geographic area is measured using outcomes data stated in educational, social, physical, mental and economic terms. These data are used to continuously improve the physical, mental, and social health services of the area.
8. Local efforts are linked with, and have the ability to influence, the State political and administrative processes.
9. State government monitors the overall health status of the population on a geographic basis, using well-defined and accepted outcomes indicators.
PRINCIPLES OF FINANCING IN AN INTEGRATED SYSTEM AN INTEGRATED SYSTEM
1. Any financing system will align the incentives in the common goal of achieving measurable, commonly agreed upon, outcomes.
2. Any financing system will ensure access to services of the system for every person in an area.
3. Financing of the system will focus on the health needs of a defined population.
4. Redistribution of funds among system components will be allowed to achieve improved outcomes, with special emphasis on funding wellness and preventive medicine interventions.
5. Funds "saved" in a community will remain in that community to finance other needed services also designed to improve outcomes.
6. The State will need to develop and maintain financing mechanisms to ensure a basic level of services for all Vermonters.
7. Information will be made available regarding the impact of health care expenditures to both the individual and the area.
8. The impact of lifestyle choices on the cost of health services for the system will be identified.
OUTCOMES
The following are broad goals on which local efforts should be focused:
1. All children are born healthy.
2. All infants and pre-schoolers are healthy.
3. All children arrive at the school door healthy and ready to learn.
4. All children - especially teens - in school avoid high risk behaviors, and live in stable self-sufficient families.
5. All adults are healthy, self-sufficient, and live as independently as possible in safe and supportive communities.
6. All Vermonters receive supportive care and comfort in their community in the face of declining health or terminal illness.
EXAMPLES OF EXISTING VERMONT INDICATORS FOR
MEASUREMENT OF INTEGRATED SYSTEMS OUTCOMES1. All children are born healthy.
Percent early prenatal care (entry in 1st trimester)
Percent low birthweight (under 5.5 pounds)2. All infants and pre-schoolers are healthy
Infant mortality rate (deaths before 1 year; rate is per 1000 births)
Rate of full immunization at kindergarten entry (data system to be developed)
Rate of injuries (age 0-9) resulting in hospitalization (rate is per 1000 population) (County-level data)
Child mortality rate (deaths from all causes; ages 1-14; rate is per 1000 population)3. All children begin their schooling healthy and capable of learning.
Percent of children perceived by kindergarten teachers as ready for school
Percent of children with reading proficiency at Grade 3
Percent of children performing at criterion or better on Math and Writing portfolios and New Standards Reference Exams (4th grade)4. All children--especially teens--in school avoid high risk behaviors, and live in stable self-sufficient families.
Percent high school dropouts
Teen violent death rate (homicide, suicide, injuries; rate is per 1000 population) (County-level data)
Percent of students using tobacco within last 30 days
Percent of students using alcohol within last 30 days
Percent of students using marijuana within last 30 days
Rate of teen sexually-transmitted diseases (combines syphillis,chlamydia, and gonorrhea; rate is per 1000 population aged 15-19) (County-level data)
Teen pregnancy rate (15-17-yr.-olds; rate is per 1000 female pop.)
Percent of new families at risk (1st births to unmarried women < 20 yrs. old with <12 yrs. education)
Rate of injuries (age 10-17) resulting in hospitalization (rate is per 1000 population) (County-level data)
Rate of delinquency (average daily rate per 10000 population, aged 0-17 yrs.)
Rate of unmanageables (average daily rate per 10000 population, aged 0-17 yrs.)
Rate of child abuse, total (substantiated victims, ages 0-17; rate is per 10,000 population)
Rate of out-of-home placements (under 18 years old) (includes Education, SRS, Corrections, MH/MR) (County-level data)5. All adults are healthy, self-sufficient, avoid high risk behaviors and live as independently as possible in safe and supportive communities.
Percent of high school seniors with post-graduation plans for education, vocational training, or employment
Rate of out-of-home placements (18-24 years old) (includes Education, SRS, Corrections, MH/MR) (County-level data)
Rate of injuries (age 18-24) resulting in hospitalization (rate is per 1000 population) (County-level data)
Rate of injuries (age 25-64) resulting in hospitalization (rate is per 1000 population) (County-level data)
Rate of injuries (age 65+) resulting in hospitalization (rate is per 1000 population) (County-level data)
Percent child support paid (total collections as a percentage of amount payable) (County-level data)
Rate of adult abuse/neglect (reports per 1000 population aged 18+)
Rate of out-of-home placements (25+ years old) (includes Education, SRS, Corrections, MH/MR) (County-level data)
Rate of suicide (rate per 100,000 population: < 18 yrs.; 18+ yrs.)
Percent of adults who are smokers (County-level data)
Percent of adults who are "binge drinkers" (County-level data) (indicator under review)
Rate of death from cardiovascular disease (heart disease and stroke) (all ages)
Rate of death from cancer (all types, and separately for lung, breast & cervical, and colorectal & prostate) (all ages)
Rate of death from pneumonia & influenza (all ages)
Rate of death from diabetes (all ages)
Rate of death from motor vehicle crashes (all ages)
Rate of infectious diseases (campylobacter, pertussis, chlamydia, AIDS) (all ages)
Rates of overweight and inactivity (age 20+)
Percent people above poverty level, 1990
Percent children in poverty (County-level data)
Average median income,1989
Rate of job creation (net percent change in annual average number of private-sector jobs) (County-level data)
Rate of employment (annual average percent of labor force employed) (County-level data)
Average annual wage (County-level data)
Rate of violent crime (includes reported homicide, rape, robbery, and aggravated assault; rate is per 100,000 population)
Estimated percent met need for child care, 1994 (based on existing regulated child care slots, and estimated need equal to 50 pct. of the 0-14 population) (District-level data)
Percent of households that are affordable, 1990 (defined as housing costs totaling less than 30 pct. of gross income) (County-level data)6. All Vermonters receive supportive care and comfort in their community during times of declining health or terminal illness.
Percent of population in nursing homes (data may not be available at a sub-state level)
Percent of population in other publicly-funded long-term care facilities (data may not be available at a sub-state level)
Rate of adult guardianship (per 1000 population aged 18+)
Percent of people aged 65+ who die at home, nursing home (non-acute causes) (data may not be available at a sub-state level)
For more information contact: Bea Grause at (802)-223-3461 or bea@vahhs.org
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