Vermont Department of Health

CAH Quality Improvement

In FY 2021, Vermont’s Flex Program contracted with a statewide quality improvement organization, Vermont Program for Quality in Health Care, Inc. (VPQHC), to provide one-on-one technical assistance to CAHs after collecting Letters of Intent (LOIs) from each of eight CAHs to meet the minimum MBQIP participation requirements.  VPQHC managed the contracted activities and reported results to the Flex Program periodically as required.

Vermont hospitals, including CAHs, are required by statute to submit HCAHPS and other key quality data regularly.  All eight Vermont CAHs reported the Antibiotic Stewardship measure to NHSN. Additionally, five CAHs reported HCP-IMM data during this budget year. Four met or exceeded the national benchmark/median of 92%; the remaining CAHs reported 90%.

Despite the challenges of the pandemic and a change of EDTC measures and national MBQIP data aggregators, only two CAHs increased their proficiency at communicating well with patients being transferred from the Emergency Department.

CAH Operational and Financial Improvement

1. Conduct a needs assessment to identify and address barriers to full participation by a wide range of health care providers in OneCare Vermont, the single, statewide Accountable Care Organization (ACO) within Vermont’s CMS-approved All-Payer Model (APM) for health care reform.

2. Vermont Program for Quality in Health Care, Inc. (VPQHC) and Green Mountain Care Board (GMCB) will develop “Quality Framework" applicable and appropriate to most providers in the statewide ACO.

VPQHC worked closely with staff from the Green Mountain Care Board (GMCB), Vermont’s health care regulatory body, and Vermont Association of Hospitals and Health Systems (VAHHS) to conduct a national and statewide environmental scan of resources and best practices. Additionally, this team surveyed hospital leaders to identify key barriers to full participation in the statewide Accountable Care Organization (ACO), OneCare Vermont.

CAH Population Health Improvement

The roles of the Flex staff in this project were to 1) manage the CRF funds allocation as a sub-grant to VPQHC, our usual QI partner for MBQIP, and 2) to use Flex carryover funds to conduct a thorough evaluation of the Connectivity Care Package (CCP) pilot project for possible expansion with additional partners and patients should funding become available. 

The Flex-funded evaluation of the CCP found that: VPQHC established relationships with 58 new health and social service partner organizations and distributed 1,325 iPads and 550 Wi-Fi boosters to providers and patients in all 14 Vermont counties. VPQHC estimates “that over 7,000 telehealth visits occurred as a result of the CCP equipment having been shared.”

Partner organizations included rural and critical access hospitals, assisted living and low-income housing facilities, FQHCs, homeless shelters, nursing homes, private practices, and other providers. Some of these providers serve multiple households of eligible patients and set up ‘lending libraries’ for iPads to be set up, stored, maintained, sanitized, and re-lent to others for telehealth visits, health and wellness programming, connecting to families and friends, social media, etc.

Due to the compressed timeline of this project and many other pandemic-related stressors, only a preliminary evaluation was completed before the Flex budget year ended August 31, 2021. At that time, survey “data have been received from employees at 20 of the 55 participating CCP sites” and only 2 patients/clients. However, one statewide partner Support And Services at Home (SASH) presented their collaboration with VPQHC at the New England Rural Health Association (NERHA) annual conference in November 2021.

SASH partners (22 employers) set up and distributed 267 iPads to various multi-household sites across the state and instituted an iPad Loaner Program for participants.  

Use of Flex funding to evaluate this major investment and distribution of telehealth equipment greatly enhanced access to important telehealth care and social connection during the pandemic. With 8 of Vermont’s 14 hospitals being CAHs, many patients normally served by CAHs benefited from the Connectivity Care Packages distributed to partners then made available to homebound patients.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:

No