The Vermont Blueprint for Health: Redefining Primary Care

The following is an excerpt from our 2011 Annual Report. Our 2012 Annual Report will be out soon.

Vermont Blueprint

Blueprint Care Coordinator Keith Marino meets in Gifford primary care with patient Cheryl Abbey of Randolph.

The Vermont Blueprint for Health is a state-led initiative aimed at improving care coordination, especially for the chronically ill. The goals of the initiative are to improve health, enhance the patient experience and reduce, or at least control, health care costs.

This is accomplished through what the Blueprint is calling “advanced primary care” that seamlessly coordinates a broad range of health and human services for patients and their families.

In 2011, the Vermont Blueprint for Health came to life at Gifford. Each of the medical  center’s primary care practices was recognized as a Patient-Centered Medical Home and a huge care coordination effort got under way to meet patients’ diverse needs.

The care coordination effort, which is supported in part by grant dollars, is twofold. First, Gifford formed its own small care coordination team made up of three core employees; Blueprint Care Coordinator Keith Marino, Gifford Diabetes Educator Jennifer Stratton and
Health Connections Caseworker Michele Packard. Second, a larger Community Health Team consisting of a diverse group of state and regional community housing, aging and disability agencies as well as eye care professionals, a pharmacy, insurers and more, was formed.

Vermont Blueprint

Blueprint core team members – Health Connections caseworker Michele Packard and diabetes educator Jennifer Stratton – meet weekly with Blueprint Care Coordinator Keith Marino at the Bethel Health Center to discuss individual patients and how to better serve them.

The Community Health Team meets quarterly while a care coordination team meets weekly. More importantly, referrals are bouncing back and forth between the agencies and teams ensuring patients are getting the services they need to maintain and improve their health. Keith coordinates this work, meeting directly with patients, spending time in each
of Gifford’s Patient-Centered Medical Homes, conferring with health care providers and helping patients access needed services.

Patients and community members are referred to Keith for a huge variety of reasons. They may need help managing chronic conditions, be struggling socio-economically, need mental health assistance, be disabled or elderly, have housing or transportation needs or just need help navigating the health system.

The Blueprint provides that help directly or refers them to an appropriate community agency. The help comes in the form of one-on-one meetings with Keith and outreach on his part to get the patient connected with needed resources.

“My role is to make sure patients are getting access to proper services, which enables them to self-manage their chronic condition,” Keith says.

Medicine Division Vice President Teresa Voci gives the example of a chronically ill patient who, because of financial pressures, has to choose between food and medication. Without medication, their health suffers. With the Blueprint services, their health care provider has a central resource to offer the patient for those issues that fall outside the health care setting but are barriers to care, like help with finding resources to buy food and medications.

Kim Flood of Barre is a real life example.

All three of Kim’s sons were diagnosed with asthma. The younger two, ages 4 and 1, were especially sick, including being hospitalized. Kim thought she knew the problem – mold in her Barre apartment.

Pediatric hospitalist Dr. Lou DiNicola referred Kim to the Blueprint. “Keith helped us find someone to do mold testing, help us with legal aid,” Kim says, “and he got city officials to come to the apartment. I had tried for months to get the housing inspector and building inspector to our house. I just got the runaround from everyone.”

With the mold verified and the help of legal aid, Kim settled with the landlord and in October moved into a home she bought in Barre Town on nine acres.

The kids haven’t been sick since.

Kim is one of 230 referrals Gifford’s Blueprint team has received since Keith was hired and the program got under way in February, notes Blueprint Project Coordinator LaRae Francis. Most of the referrals are from primary care providers, like Dr. Terry Cantlin of the Bethel Health Center.

“He’s been invaluable,” says Dr. Cantlin of Keith, who does the work primary care physicians simply do not have time to do in their busy practices.

Now if a patient is not taking their medication due to financial pressures, is missing needed appointments because of transportation issues or struggling with social issues – all scenarios Dr. Cantlin sees – he now has a one-stop resource for the patient.

It also prevents patients unaware of available community resources from “falling through the cracks,” says Mary Ellen Otis, executive director of the Orange County Parent Child Center in Chelsea.

That center, which provides a vast array of family services from new baby visits to parenting education, is part of the Community Health Team and refers clients to Gifford as well as gets referrals from the hospital. Under the new coordinated effort, Mary Ellen says, referrals are now far more efficient.

Maryette Withington can attest to that.

The Barnard resident has a relative with Alzheimer’s disease. Dr. Cantlin referred Maryette to Keith for help learning more about the disease. He met with her at the Bethel Health Center and connected her with the Randolph Area Senior Center and the Vermont Chapter of the Alzheimer’s Association. Within 24 hours Maryette had information in her hands about the disease that she says has changed everything in her life.

“You’re totally responsible for that person. I just needed to know what to expect.”

She will have an ongoing relationship with the association and also continues to receive help from Keith, Dr. Cantlin and her Gifford health care team. It’s help she appreciates. “I have the best health care team in the world,” she says.

Need help yourself? Call the Blueprint Care Coordinator at (802) 728-2499.

Prepared for an Emergency

prepared for an emergency

Medical Assistant Noreen Fordham practices evacuating a patient, Surgical Associates Manager Sherry Refino, down a flight of stairs.

The following is an excerpt from our 2011 Annual Report.

In a disaster, the local medical center is a needed resource. With rooms filled with bed-ridden patients spanning multiple floors, a medical center must also be prepared for an emergency within.

Last year, Gifford held one of its largest emergency preparedness training events in recent years. In intense trainings held over two days, a total of 80 employees learned firsthand how put out a fire, communicate via emergency radios, and evacuate patients. They studied the locations of exits, emergency phones and medical gas shut-off valves. They learned about decontaminating patients and personal protection, and dealing with aggressive people.

emergency preparedness

Environmental Services Manager Ruthie Adams learns to use a fire extinguisher.

Ruthie Adams, Environmental Services manager, was among those who went through the training.

“I think it benefits the entire organization to have folks who understand key and critical points, especially non-clinical staff, such as how to evacuate a patient using an Evacusled, how to communicate on a radio properly, and just being a key go-to person in the event of an emergency,” says Ruthie, who used a fire extinguisher for the first time and now uses radio communication in her job.

The training was just one way Gifford prepares for an emergency. Employees take annual courses and exams electronically on workplace safety, such as fire, electrical, disaster preparedness, and violent situations.

prepared for an emergency

Staff practice securing a patient, played by Environmental Services Team Leader Ralph Herrick, in the new Evacusled, used to evacuate bed-ridden patients.

A 2010 grant supported a study, changes, and significant educational outreach on Gifford’s emergency codes. These codes are what employees hear called out as overhead pages during emergencies and include codes from fire to cardiac arrest to a violent situation.

Monthly fire drills are held regularly throughout all shifts and in varying areas of the hospital.

preparing for emergencies

Physical therapist Patrice Conard and materials clerk Alice Whittington participate in a scavenger hunt utilizing their newly learned radio communication skills.

Director of Quality Management Sue Peterson defines an emergency as “anything that stretches the limits of our normal operations.”

Prior to October’s larger training, smaller emergency trainings were held with managers and facilities staff on radio use and responding to a “code amber,” which is a missing patient or person. Future drills on other codes are planned.

When mass casualty situations like a bus accident with multiple victims arise, which they occasionally do, follow-up meetings are held to discuss what went well and where staff needs to make improvements. An essential Emergency Operations Plan has been
painstakingly updated over the last year, detailing Gifford’s response to a variety of emergency circumstances. The plan continues to be updated so hospital staff can remain ready to address changing threats and adverse events.

emergency preparedness

“As a medical center committed to our community and as Vermonters with a can-do attitude, we do well,” says Sue. “But preparing for the diverse threats in today’s world is a huge task. Emergency preparedness planning is essential to ensuring that we as a caregiver keep our patients safe in a crisis.”

A Conservative Approach to Health Care Reform

The following is an excerpt from our 2011 Annual Report.

health care reform

Information Systems Director Sean Patrick sits amid the old way of keeping patient records – paper files – and the new way to come – electronic medical records updated by providers via new laptops or even iPads.

As lawmakers embark on an ambitious schedule to create a health care exchange required under the federal Patient Protection and Affordable Care Act by 2014 and a Vermont single-payer system by 2017, Gifford is mindful of its role as a community care provider.

The laws seek to bend the health care cost curve, in part through information technology, advanced primary care and payment reform.

Through the implementation of Vermont Blueprint for Health initiatives, Gifford is embarking on reform initiatives including care coordination for the chronically ill and recognition of Gifford’s five primary care practices as Patient-Centered Medical Homes.

The medical center has chosen an electronic medical record (EMR) vendor and is progressing toward both the installation of an EMR system and meeting federal requirements for “meaningful use” of electronic health records (EHRs). EMRs are internal electronic medical records. EHRs can be viewed by appropriate outside entities, including specialists and providers from other hospitals.

Gifford’s modest budget requests and responsible spending also align with reform, notes Trustee Paul Kendall, who actively follows reform legislation.

But the non-profit community medical center is by choice not at the forefront of reform efforts.

Gifford Administrator Joe Woodin likens health care reform to a passing ship. Where others might be quick to jump on – appropriately, the region’s larger health care providers – Gifford is waiting to ensure the medical center commits to the best choice for
Gifford’s size, patients and rural area.

“Gifford is more inclined to stay on the dock and wait for the boat to come around on health care reform,” Joe says. “It takes a lot of fortitude to humbly wait for the boat to make a reiteration.”

“We continue to be watchful of what’s going on and gradually position ourselves to do
what is right and appropriate,” agrees Paul, noting some initiatives like information
technology upgrades can require huge investments of time and financial resources.

conservative approach to health care reformGifford also strives to be a voice in discussions leading up to reform legislation. Leadership is suggesting cost-saving ideas the state could pursue now. They continue to set a standard
for financial stability and maintaining strong relationships with other hospitals, state and federal lawmakers, and health care organizations, like Bi-State Primary Care and the Vermont Association (VAHHS).

VAHHS represents the state’s nonprofit hospitals before lawmakers and the Green Mountain Care Board, which was created by the Legislature in 2011 to oversee the creation of a single payer Vermont system. Bea Grause, VAHHS president and chief executive officer, sees small hospitals’ role in health care reform as one of preserving local access to high-quality care.

“Hospitals are seeking to create reform opportunities by working with the Green Mountain Care Board and federal lawmakers that will balance the need to contain costs with the need to ensure sufficient revenue that will help hospitals meet their local missions,” she says. “Issues such as recruitment and retention of physicians and other health professionals, improving quality, ensuring access and long-term financial sustainability are just a few of the challenges small hospitals will face as Vermont and the entire industry prepare for a decade of continued change on all levels.”

Gifford’s work with Bi-State Primary Care in part addresses the recruitment piece.

Bi-State Primary Care is a nonprofit membership organization of Vermont and New Hampshire rural health care providers working to support primary care practices in medically under-served areas. Its members represent more than 175,000 Vermonters. This equates to one in four residents, or 46 percent of Medicaid enrollees and 52 percent of the state’s uninsured.

The organization is working on Gifford and small, rural primary care practices’ behalf to improve access by recruiting providers to underserved areas. They are also working on health information exchanges and quality improvement initiatives.

The ultimate challenge the state – and likely hospitals by default – will face for successful health care reform, however, will be answering the question: “What can we afford?”

“There are a lot of uncomfortable issues with health care reform that we don’t talk about. The most common issue is ‘what can we afford,’” Joe says, hoping lawmakers will address that question. If they don’t, it will fall on hospitals, which will be given limited funds to provide care. They will have to make tough choices on what care they can afford to
provide.

Percentage of Giving By Type

The following is an excerpt from our 2011 Annual Report.

percentage of giving at GiffordEach year Gifford is fortunate to receive generous gifts from our friends.

Gifts are made to benefit specific purposes, such as technology or services, or to the general fund.

The Last Mile Ride, which raises money for end-of-life care, continues to grow in popularity and benefit patients and their families.

The pie chart shows the donations – all of which are greatly appreciated.

Pulling Together in the Face of Natural Disaster: Braintree

Braintree's response to Irene

Volunteers, including LaRae Francis and Carol Blodgett from Gifford’s lab,
stand in front of a burn pile at the site of Ken Perry’s former Thayer Brook Road
home in Braintree.

The following is an excerpt from our 2011 Annual Report.

Brenda Wright from Gifford’s Environmental Services Department was standing in boyfriend Ken Perry’s Thayer Brook Road home when it began to break apart. Irene’s torrential rain caused Thayer Brook to sweep over its banks, taking away much of Ken’s Braintree land, including that which supported the house.

They lost nearly everything, and on Oct. 28 – exactly two months after the flood – demolished the ruined home.

A group, including LaRae Francis, Carol Blodgett and Robin Palmer from Gifford, arrived the next morning to help pick up remaining debris to be trashed or burned. LaRae brought a group from her church. Carol hadn’t yet been to sleep after her night shift in the lab.

Not Just a Medical Center; A Medical Home

The following is an excerpt from our 2011 Annual Report. 

What is a Medical Home?

medical homeA medical home is an approach to providing comprehensive primary care that builds partnerships between patients, their physicians and, when appropriate, their families.

The American Academy of Pediatrics was at the forefront of the medical home movement, detailing decades ago that every child needed a place where care was accessible, ongoing, patient and family-centered, of high quality, coordinated, and compassionate.

Today, those philosophies have been expanded to adults as they’ve been adopted by family practice and other health care associations.

In fact, the National Committee for Quality Assurance, a non-profit dedicated to improving health care quality, is now recognizing qualifying medical practices as Patient-Centered  Medical Homes.

medical center

Bethel Health Center family physician Dr. Terry Cantlin talks with patient Eileen Strickland-Holtham of South Royalton during a routine exam. The Bethel Health Center is one of five Gifford practices recognized as a Patient-Centered Medical Home.

Patient-Centered Medical Homes

Achieving the Patient-Centered Medical Home recognition is part of the Vermont Blueprint for Health’s goals for all primary care providers in the state.

The hope is to improve primary care so patients are getting regular needed care and other supports to maintain their health before facing more costly emergency or inpatient care.

“The medical home adopts a ‘whole person’ approach to primary care, encompassing medical, behavioral and self-management support,” says Gifford Blueprint Project Coordinator LaRae Francis. “It’s the entire health care team wrapping its arms around the patient to provide the support and resources he or she needs to manage his or her health
conditions.

“It aims to keep people healthier, enhance their quality of life and benefit them financially, both through reduced health care costs and secondary costs such as missed work.”

In 2011, each of Gifford’s primary care practices – the Gifford Health Center at Berlin’s pediatrics practice, the Bethel Health Center, the Chelsea Health Center, Gifford primary care in Randolph and the Rochester Health Center – was recognized as a Patient-Centered Medical Home following inspections by the National Committee for Quality Assurance.

The health centers, which serve a total 21,540 patients, each formed quality improvement teams to address expectations for a Patient-Centered Medical Home, primarily through honing and streamlining systems. Among those expectations, or standards, were access to care, communication, such as through timely callbacks to patients and tracking referrals and tests, such as lab results to ensure they are communicated back to the patient.

The process, says Vice President of Medicine Teresa Voci, allowed the health centers to identify and correct problems. It’s all work done behind the scenes, but also all work that makes care more timely for patients.

Labs, X-rays and referrals to specialists are all now better tracked to ensure the patient and the primary care provider know the results of those exams, notes Chelsea Health Center site manager and nurse Travis Worthen. Providers are also more often meeting with patients to go over results.

And the patient is increasingly a bigger part of the health care team.

“Historically, medicine has always told patients what to do and now medicine is really turning toward engaging the patient in a partnership for health outcomes,” Teresa explains.

Blueprint project coordinator

Blueprint Project Coordinator LaRae Francis has headed up efforts to implement the Vermont Blueprint for Health at Gifford and in the larger Randolph Health Service Area.

The work doesn’t stop with Gifford.

With the medical center’s primary care locations now all recognized, LaRae, as Blueprint coordinator for the Randolph Health Service Area (a Blueprint-defined area spanning from Randolph to White River Junction), is now looking outside of Gifford. She’s reaching out to White River Family Practice in Wilder and the South Royalton Health Center.

She hopes to help these private health centers also earn the recognition, further improving patient care in our region.

Donor Profile: The Gifford Medical Center Auxiliary

The following is an excerpt from the 2011 Annual Report.

Facilitating a circle of giving

Gifford Auxiliary

Linnie Laws, Kathy Corrao, and Ginny Cantlin knit and crochet hats and mittens for area school children in need. In 2011, 150 pieces were made by
Auxiliary members and their friends.

The Gifford Medical Center Auxiliary is an organization both supported and motivated by donations. Among the medical center’s largest monetary contributors, the now 105-year-old Auxiliary is able to give so much because of the generosity it receives from the
community and its 135 members.

Auxiliary members knit hats and mittens for school children in need and contribute to the Randolph Area Food Shelf and Salvation Army. They help area youth and other area residents pursue health care careers or advance their careers through scholarships. They also volunteer at the Thrift Shop.

A staple in the community for 55 years, the Thrift Shop on the surface is a place to buy bargain-priced wears. Seemingly immune to any stereotypes the Thrift Shop is a source of pride for its shoppers, a daily gathering place for some and a resource to many truly in need.

“Terrible times have fallen upon us, and I just don’t know what to do,” Thrift Shop Manager Dianne Elias often hears. “When people are in true need, they know they can come to us.”

The Thrift Shop is also the main source of revenue for the Auxiliary’s generosity, and it is the community’s place to recycle good quality, unwanted clothes, and small household items, like kitchen ware and linens. The community’s generosity in giving to the Thrift Shop is evident in the piles of boxes and bags that fill the business’ receiving dock each day, but a single event in 2011 highlighted that generosity like no other, and that was
Tropical Storm Irene.

Many families lost everything, and Vermonters sprang into action.

“Every single person wanted to help,” recalls Dianne, “but didn’t know how to help, so they cleaned out their closets.”

The Thrift Shop was inundated.

“The generosity of the Vermont people was literally overwhelming,” says Auxiliary President David Peirce.

Gifford Auxiliary sale

Community members crowd into a tent filled with giveaways following
Tropical Storm Irene.

The dock overflowed. Donations filled all available storage space at the store and neighboring hospital. David counted the cars pulling up – 12 an hour, or one every five minutes. It went on for weeks. Eventually on a chilly October weekend two months after the flood, the Auxiliary held a giveaway and in the continued spirit of community, everyone pitched in.

The Thrift Shop’s 40 volunteers sorted the donations into men’s, women’s, pants, shirts, etc. Randolph Union High School Encore Theater Co. students worked with advisor Brian Rainville to carry the clothes from storage to tables set up under a tent. Their volunteer work was in thanks for the many costumes the Thrift Shop provides to the school.

Students from Tom Harty’s public safety and criminal justice class at Randolph Technical Career Center guarded the clothing overnight in below-freezing temperatures for the sale the next morning. In typical grateful fashion, the Auxiliary thanked them with a donation to their program.

Gifford Auxiliary sale

The same tent by 4 p.m. that afternoon.

The sale was scheduled to last two days: Saturday, Oct. 29 and Sunday, Oct. 30, but by 4 p.m. Saturday nearly everything was gone.

Of course, the donations kept coming in and plenty of goods along with vouchers for free items were offered to families rebuilding after Irene. Fire victims and others in need also often receive free goods.

For paying customers, their spending at the Thrift Shop ultimately goes to the medical center and its patients. In 2011, the Auxiliary supported Gifford’s Affordable Care Program, providing free and affordable care to patients in need. It fulfilled departments’ “Wish List” requests, bringing added equipment to patients utilizing the lab, Pediatrics, the Emergency Department, Pulmonary and Cardiac Rehabilitation programs, the Bethel and White River Junction health centers and more.

Volunteers gave more than 4,500 hours in 2011 at the Thrift Shop to make that giving possible. Auxiliary board members also give significant time to the non-profit volunteer-run organization.

The reasons why they do this are diverse, but all come down to one main motivation: supporting their community and their community hospital.

2011 Gifford Admissions and Visits by Top 20 Towns

The following is an excerpt from our 2011 Annual Report.

For those of you interested in statistics, here are Gifford’s admissions and visits from 2011. (We’re reporting only the top 20 towns.)

                                                          Inpatient              Outpatient                  Total
Randolph/Braintree                           562                       21,620                   22,182
Bethel                                                   150                         6,373                      6,523
Royalton                                               119                         5,296                     5,415
Northfield                                             138                         3,661                     3,799
Chelsea                                               111                         3,052                     3,163
Rochester                                              82                         2,461                     2,543
Barre                                                       73                         3,175                     3,248
Tunbridge                                              29                         2,354                      2,383
Brookfi eld                                             55                         2,256                      2,331
Berlin                                                      62                         1,505                      1,567
Sharon                                                   28                         1,495                      1,523
Williamstown                                        60                         1,312                      1,372
Stockbridge                                           23                         1,048                      1,071
Granville                                                25                             754                         779
Hancock                                                19                             657                         676
Pittsfield                                                12                             481                         493
Barnard                                                   6                             483                         489
Washington                                         15                              430                         445
Montpelier                                              9                              333                         342
Woodstock                                             4                             314                          318
Other Vermont towns                       207                          8,973                      9,180
Other states                                         21                          1,673                      1,694
Other countries                                     1                                  1                              2
Grand total                                     1,811                        69,707                   71,518

Gifford admissions

Infant and Child CPR Classes Upcoming

infant CPR courseRANDOLPH – Gifford Medical Center will offer non-certification Infant and Child CPR classes on Aug. 15, Nov. 15 and Feb. 13.

The classes are for parents, other family members, friends and caregivers of infants and children and will be held from 6-8 p.m. in the Family Center at Gifford. Participants need only take one class.

The classes will be led by experts from White River Valley Ambulance service in Bethel and are organized by care manager and certified childbirth educator Nancy Clark of Gifford.

The class cost is $20, which is reduced thanks to a gift from the Lamson-Howell Foundation of Randolph.

Call Clark at 728-2274 to register or for more information.

The Family Center is beside Gifford Ob/Gyn & Midwifery located just before the hospital on South Main Street (Route 12) in Randolph.

‘Two for the Show’ Coming to Gifford Park

Sanie Bly and Wayne Ladd RANDOLPH – Local couple Sanie Bly and Wayne Ladd bring their group “Two for the Show and Company” to the Gifford Medical Center Park on Thursday, Aug. 2 for a free concert.

Bly and Ladd, known for their past performances at the Three Stallion Inn, sing and play “boomer music and everything in between.”

Expect everything from Fats Waller to Jefferson Airplane, rounded out with a little Lulu, says Bly.

Bly works at Gifford. “I’m excited to play for co-workers and friends and to be part of Gifford’s new community concert series,” she says.

The performance is from 7-8:15 p.m. and is free and open to the public.

The Gifford park is located between the hospital and the Thrift Shop on South Main Street (Route 12) south of Randolph village. Ample parking is available onsite.