Vt.: Manage the chronically ill

SOUTH BURLINGTON, Vt. (AP) — What could play a central role reforming the nation’s health-care system happens in a small conference room of the Aesculapius Medical Center — two patients learning the basics of managing their diabetes.

The pilot program begun in 2003 aims to reach patients with chronic conditions, keep them healthier and, ultimately, save money by heading off expensive hospitalizations and procedures. Already, emergency-room visits are down.

It’s health care at its most basic, but in some ways, it’s revolutionary. In a system where private insurers and the government reimburse providers for treating sick patients, the physicians who treat the two diabetes patients will get more if they stay healthy.

Almost 85 percent of Vermonters age 65 and older have one chronic condition — such as diabetes, asthma or cardiovascular disease — and many have more than one. Treating chronic conditions accounts for 78 percent of health-care spending in Vermont and 88 percent of all prescriptions. Experts say those figures are similar across the country.

Variations on Vermont’s Blueprint for Health are being used as a model in the national health-care reform legislation now being considered by Congress, said Ken Thorpe of Emory University in Atlanta, who helped develop the Vermont program and is working with Congress on national reform.

The Vermont Legislature has passed a series of laws requiring the state’s three major health-care players to reimburse the patients’ providers for their care. Plans aim to expand the project statewide by 2012.

At Aesculapius, registered nurse Pam Farnham goes over with the patients the best way to manage their diets and explains how diet and exercise can help minimize their symptoms and, hopefully, keep them healthier and out of the hospital.

“There’s a lot more that I learned here than I did when I was in the hospital,” said Peter Benoit, 62, of Colchester, who attended his first diabetes class recently at his South Burlington doctor’s office. “In this setting, you understand more of what is going on and what you have to do to get yourself under control.”

The Blueprint allows physicians to spend more time with their patients, helps track their conditions and gives patients access to services they wouldn’t otherwise have taken advantage of. It also rewards physicians for keeping patients from getting sick.

“I think I am a better doctor because of this, and I’m a more satisfied doctor because of this,” said Dr. Jennifer Gilwee, an internal medicine specialist at Aesculapius.

The better a Blueprint provider does, the more it gets paid. The system uses statistics from the National Committee for Quality Assurance, a national nonprofit organization that measures health-care performance.

The program is getting recognition from the federal government, too. Last month the Obama administration announced a new, three-year Medicare pilot program based on the Vermont program.