Prevention: Health Equity and Health Reform

Prevention: Health Equity and Health Reform

Health Equity –  Health equity is defined by the Vermont State Health Improvement Plan, 2019-2023: “Health Equity exists when all people have a fair and just opportunity to be healthy – especially those who have experienced socioeconomic disadvantage, historical injustice, and other avoidable systemic inequalities that are often associated with social categories of race, gender, ethnicity, social position, sexual orientation and disability.”

In 2021, the Vermont Department of Health was awarded a CDC Health Disparities Grant.  The CDC grant will draw upon pre-COVID planning to create greater health equity and lessons learned throughout the response to build ongoing capacity to assure future plans, activities, and resources to prevent COVID infection (or transmission) and address persistent health inequities in Vermont.

Vermont Community Health Equity Partnership – The VtPHI was contracted to assist health equity capacity building in Vermont Department of Health Districts by providing a collaborative learning structure; and recruiting, hiring, and training district-based staff to facilitate and coach designated local community groups and residents in activities and interventions to reduce health disparities and improve health equity.

Working with the Vermont Department of Health Office of Local Health, VtPHI will:

  • Create with the Office of Local Health opportunities for a diverse range of community members and partners to collaborate to build healthier, more resilient communities.
  • Provide technical assistance and oversight to Office of Local Health District Office as they form community collaboratives, and develop action plans.
  • Provide technical assistance and oversight to community collaboratives as they implement and evaluate action plans over an 18 month period, and develop plans to sustain their work over the long term.
  • Provide opportunities for training and technical assistance to collaboratives by convening regular Learning Community sessions.
  • Support and promote with the Office of Local Health, innovative, community-led approaches to improve community resilience.
  • Support and promote with the Office of Local Health, place-based strategies to promote healthy communities and eliminate health disparities.
  • Engage with the Office of Local Health and the community to reach the identified grant goals.

The work of VtPHI is threefold:

  • Learning Collaborative. Establishment and support of a statewide “Learning Collaborative,” the purpose of which is to support the twelve Vermont Department of Health Districts’ (Districts) use of community collaboratives to address health inequities laid bare by the COVID pandemic.
  • Backbone. In collaboration with the Districts, engage “backbone” support for their community collaborative(s) to address health inequities.
  • Supporting Local Work.  As part of the work of the Learning Collaborative and in collaboration with the Districts and the community collaborative in each District, implement a process to provide funding to local non-profit organizations to address the goals of the CDC project.

VtPHI logic model for the CDC grant

Homeless Health Equity Capacity Building – People experiencing homelessness often have inconsistent access to health services and supports. They have been disproportionately impacted by COVID. Community agencies that provide homeless shelter and services are knowledgeable and trusted entities amongst this impacted population. These agencies have been essential partners in providing testing, contact tracing and vaccinations to people experiencing and at risk of homelessness.

During COVID 19, the local homeless Continuums of Care (CoC) organized local COVID homeless response teams to identify gaps in prevention and response efforts, mobilize new resources and strategies, and provide ongoing coordination and information sharing. Developing partnerships with public health and health care providers, supporting the development of new local resources and strategies to promote health amongst the impacted population, and providing ongoing coordination of efforts requires new resources for community agencies to be effective partners.

Vermont Public Health Institute (VtPHI) will provide capacity-building consultation services to the Northeast Kingdom Local Homeless Continuums of Care (CoC) covering the Newport and St. Johnsbury regions to develop a consolidated strategic plan to better enable regional agencies to collaborate with public health and health care to address COVID-19 and other health needs.

Health Reform – In the spring of 2019, the Vermont Public Health Institute received a grant from the Vermont Department of Health’s Office of Rural Health and Primary Care to survey Vermont’s critical access and rural hospitals on their institutions’ readiness to move to Value Based Reimbursement.  Hospitals were invited to voluntarily complete a Self-assessment promulgated by the National Rural Health Resource Center, “Performance Excellence Framework: Key Questions for Rural Hospitals Assessment.”  Aggregated results from completed self-assessments will assist the Office of Rural Health in planning for use of FLEX (Medicare Rural Hospital Flexibility) and SHIP (Small Hospital Improvement Program) funds.

In addition to information from the self-assessment, each hospital has been asked to participate in an on-site meeting to discuss broad questions about FLEX and SHIP funding, how Community Health Needs Assessments have contributed to its strategic planning, and its experience of and expectations for the Accountable Community for Health initiative it its region.

All the results will be combined in a report that will be offered to all hospitals and interested others in early 2020.

Accountable Communities for Health Peer Learning Laboratory

VtPHI is providing facilitative support to ten (10) regional partnerships in a year-long peer-learning project to create Accountable Communities for Health. This project will bring together leaders from health care, public health, and community organizations partnering in emerging Accountable Communities for Health within Vermont to learn with and from one another and from national innovators about strategies to address the non-clinical social, economic and behavioral determinants of health and incorporate primary prevention efforts that address the health of the whole population.

VtPHI support includes identifying the practical steps in creating structures and sustainable funding to integrate clinical care and community wide prevention strategies. Support will include pulling together local leadership; identifying potential governance; reviewing existing data and systems; and determining opportunities for creating permanent structural changes.

The Plan for Integrating Population Health and Prevention in Health System Innovation

VtPHI has been hired to write for The Plan for Integrating Population Health and Prevention in Health Care Innovation in Vermont for the Vermont Health Care Innovation Project (VHCIP) – Vermont’s SIM Grant with the Centers for Medicare and Medicaid (CMMI). This plan will recommend a strategic pathway forward to integrate population health and prevention in future reforms aimed at saving money, ensuring health care quality and improving health. Specifically, the Plan will:

  • provide analysis of opportunities through the payment and care models being tested in Vermont’s health system reforms being tested through VHCIP:
  • outline population health measures to be used in tracking the outcomes of VHCIP and to be incorporated in the new payment models;
  • recommend payment reform mechanisms, and promising new financing vehicles that promote financial investment in population health interventions; and
  • describe a pathway and alternate structures to improve population health through better integration of clinical services, public health programs and community based services at both the practice and the community levels.