 Good afternoon, everyone. I see that all the board members are here. My name is Kevin Mullin, chair of the board. And the first item on the agenda is the executive director's report, Susan Barrett. Great, thank you, Mr. Chair. Good afternoon, everyone. First, I wanted to update the schedule for folks for the board and the public. First, tonight we have a primary care advisory group meeting that starts at 5 p.m. We've invited the director of healthcare reform at the Agency of Human Services, along with Alayna Barabee, and that is Ina Bacchus. She does have a name. Along with Alayna Barabee, our director of value-based payment at the board will be presenting to the primary care advisory group the same presentation that they shared with chair Mullin at the general advisory group. And that was, I believe, last week. Time flies in a weird way during this pandemic. But we did ask our general advisory for advice on informing the next potential model with CMS as co-signatures on that model and really leaders in the design of the model, AHS and the director of healthcare reform were part of that presentation to the general advisory and again to the primary care advisory group tonight. We've also added to the schedule meeting next week, which we will provide to the board our overview of the annual report that we submitted earlier this year to the legislature and that is the Green Mountain Care Board annual report. Last, well, second to last in terms of announcements and a last item on the schedule tomorrow morning, we will be in the House of Regulations Committee and we will be discussing our FY22 Green Mountain Care Board budget. And then just to remind folks getting back to the public comment that same presentation that was presented to the general advisory on public engagement with the all-pair model, as well as the one that's going the same presentation that will be shared with the general advisory or the primary care advisory tonight is on our public comment section and you can, if you tap on that section on our website it will bring you to the slides and then any of those comments as I mentioned earlier that the general public provides, we will also share those with our partners at AHS as I mentioned are leading some of most of the work on the design of the model. So I wanted to just remind folks of that and let me see my list. I think that is all I have. So I'll turn it back to you, Mr. Chair. Thank you, Susan. The next item on the agenda are the minutes of Wednesday, February 10th. Is there a motion? So moved. Second second. It's been moved and seconded to approve the minutes of Wednesday, February 10th without any additions, deletions or corrections. Is there any discussion? Hearing none, all those in favor of the motion signify by saying aye. Aye. Those opposed signify by saying nay. Let the record show that the motion carried unanimously. So this afternoon, the main agenda is all about learning about the Vermont program for quality and healthcare. And Kathy Fulton and Hilary Wolfley are here to basically give everyone an update on all the great work that they're doing at VPQHC. So Kathy, whenever you're ready, take it away. Okay, terrific. Thank you, Chair Mullen. And on behalf of the entire organization and our board we wanna thank you for this opportunity. I wish we could be together in person. We certainly miss convening face to face but we're very grateful to have this opportunity to walk you through our program. And Hilary and I will just kind of bounce off one another throughout the presentation. And then we've allotted time for question and answer at the end. So would that be, does that work for you, Chair Mullen? It sounds great. Thank you. So we'll jump right in. Hilary, I think is driving the slides. Yes, and I just confirmed people can see it. So we're good to go. That's important. That's the best part. So we're very happy to be here this afternoon and walk you through, Hilary, if you move to the next slide we thought we'd provide an introduction and overview of the organization and then kind of tell you our story through the lens of our funding and contracts then bring you up to speed on our current value for our stakeholders. And then as I mentioned, follow up with some Q and A. So our mission, vision and aims reflects, whoops, that VPQHC is a 501C3 not-for-profit organized and designated by the Vermont legislature back in 1988. So in 2018, we celebrated our 30th anniversary and as a well-established, well-respected statewide quality assurance organization. And we were established as an independent non-regulatory peer review committee. Our organization brings the entire spectrum of healthcare voices to focus on quality analysis and improvement. Our mission is that we improve healthcare quality in Vermont by studying the system and making it better. We serve as a reliable source for data collection and analysis on healthcare quality. We establish appropriate and effective standards and measurement tools for quality of care. We educate healthcare providers on quality improvement and inform consumers and make recommendations to policymakers on issues of healthcare quality. Next slide, Hilary. Our vision is to improve the health status of all Vermonters and our aims are that reflect the six domains of quality of the Institute of Medicine that care is safe, timely, effective, efficient, equitable and patient-centered. I'm trying to keep up here with the slides. Our statutes that define the organization include the main statute, which is 94.16 that many of you are familiar with that defines VPQAC as the statewide quality assurance organization defines the billback formula and the rules that caps our 94.16 funding at 75% of our operating budget. We are also listed in statute 1441 which defines the purpose and definitions of a peer review committee. Our stakeholder board is described in statute 1446 which designates the Vermont commissioner of health as a permanent member of the board with an unlimited term and includes consumer representation on our board of directors. Under 94.10, VPQ shall have access to the unified healthcare database for use in looking and understanding and analyzing and improving healthcare services in Vermont. And until recently we were also included in statute 9405 addressing the healthcare resource allocation plan. So next slide, Hilary. Our board of directors is a very diverse group of many valued stakeholder partners including representation from the university of Vermont, Jeffords Institute for Quality. Jason Minor is our chair and treasurer. Mary Kate Mollman is our vice chair as the second government position from the department of Vermont health access. Tracy Dolan is the secretary and chair of the project advisory committee and represents the commissioner on our board. Jessica Barnard from the Vermont Medical Society represents providers as does Todd Bauman from the Northwestern Counseling and Support Services Organization. Dylan Burns is the mental health services director at Vermont Care Partners. And Emma Harrigan joins us from VAAS, the Vermont Association of Hospitals and Health Systems. David Healy represents the business constituency as a recently retired principal of Stone Environmental. And Dr. Kate McIntosh is our insurer representative from Blue Cross Blue Shield. Otella Perry is a director of quality at Mount Skutney Hospital and Health Center and also represents the participation of the Dartmouth-Hitchcock Medical Center. Lyra Richardson recently retired from the Vermont Legal Aid Society as a consumer participant of our board of directors and Ms. Kevin Veller, previously director of outreach and enrollment of healthcare reform at DEVA is our and not large member of the board. Our board members participate in a committee structure of basically three committees that support our activities. The executive committee meets only to recruit additional board members and fill vacant seats. The finance committee of course reviews our budget oversight and development and fiscal responsibility. And then the project advisory committee provides review and oversight of project developments and work opportunities. So that's our structure and we'll move into an overview of the funding and contracts that define our work and revenue opportunities. So we'll tell our story through the projects and work we deliver. So starting with our biggest piece of our budget, is the core funding our 94-16 Quality Assurance Contract that's comprised of five substantial areas of deliverables and work focus. One of the principal areas is the Vermont Peer Review Network which is an online portal that supports our small hospitals to conduct peer review cases and information on an as needed basis. And we populate that portal with resources and volunteers that lend their expertise to support the small hospitals in instances where additional medical external review would be necessary. We also support a network of the hospital quality directors that's been needing now for over six years. This is a fantastic opportunity for the quality directors to join together and share discussion issues, barriers, best practice and resources among each other to avoid the pain of repeating possibilities of learning the hard way. This way from network conversations we can share resources that improve and float all boats higher across the network. We do the same for hospital care management directors in a network that's been meeting now for about two years. And again, the same ideas of looking at data and sharing resources, understanding comparative performance across specific measures and just building that network of colleague conversations that can help growing pains through transitions and change. And again, each of the networks has, excuse me, a portal, a password protected portal on our website to exchange documents and resources. We have a very large bucket of labeled as technical assistance that includes the items listed here on the screen, our support to the National Health Safety Network for our hospitals to submit their surgical site infection and healthcare acquired infection data for reporting in Act 53's Vermont Hospital Report Card. But in addition to those very specific tasks, the technical assistance is a very large bucket of everything from responses to legislative inquiries, orienting new quality directors and just sharing information on new opportunities, job openings and answering the phone for any kind of issue or question or assistance that could be needed through many of our networks, including the Green Mountain Care Board. Then our largest piece of work under the 9416 contract currently is the support of the statewide telehealth work group. And we'll provide a lot more detail on the group's activities since its inception. But I'd also like to mention that the statewide telehealth work group was functioning and in position prior to the public health emergency presented by the COVID pandemic. And we were very fortunate to have this structure in place prior to the onset of the COVID emergency. And the support of the statewide telehealth group was included in Green Mountain Care Board's Rural Health Services Task Force report to the legislature that was presented, I believe about a year ago. So we were very happy to have that structure in place and look forward to ongoing collaboration for sure. Another piece of information, yeah, next slide, Hilary, thank you. This is a segment of our budget and fiscal documents that is annually shared with the Department of Financial Regulation that provides the fiscal oversight of the 9416 contract. So this provides a very rolled up version of what the 9416 billback funding is allocated to and then assurance that this, that are the 9416 component is within the 75% cap. And you can see those figures at the bottom of the slide that at the point that our budget was presented to the board this past spring, we had a very, one of the smallest budget in my tenure with the organization that was very conservative at the time, but within the 75% cap, as you see at the budget presentation, it was 70% due to the allocations that we've received for the Paycheck Protection Program and the Coronavirus funding relief allocations for another contract that we'll talk about in a minute, we were able to reduce the percentage of the 9416 contract down to 25% at this recent presentation to our board of directors. So we're very pleased with our fiscal performance. Unfortunately, it's one-time funding, but we were able to literally double our budget as a result of it. And we would like to produce more budgets that look like this one, but also to give you the reassurance that DFR provides some oversight through review of this document on an annual basis. Hillary, the next slide gives you an idea of the detail that is presented on a quarterly basis to the Vermont Department of Health that provides us with what I call the programmatic oversight and our progress towards the performance measures and deliverables as stated in the project. This is a very large document with many, many lines of detail and we review this with Kelly Docherty at VDH on a quarterly basis. So next slide, Hillary. This is a screenshot of the homepage of our website and previously we had produced an annual report of the details of the information that's being presented here today, but also analysis and information about progress and improvements. That was a very large production that we conducted in-house and was a paper, largely a paper process. We had struck on a very good kind of graphic presentation of information that was accessible to many stakeholders and different partnerships, but we found that we've outgrown the need for an annual paper report and now we really plow all that effort and energy into the production of a website that is really a living, breathing resource of information and current topic links and available resources. So we've really focused on keeping this current and as a resource to all of our partners. So moving on to some of the other contracts that we deliver on. We are a subcontractor to the Vermont Department of Health and we've been performing on this subcontract since 2011. So we've been collecting 10 years of serious reportable events, reviewing the details of the events and the causal analysis and corrective action plans. This contract includes on-site visits to hospitals once every three years and now the two ambulatory surgery centers here in Vermont are included in our patient safety surveillance and improvement system. And we produce an annual report summarizing these activities that's part of the Act 53 hospital report card and is posted on the VDH website. This work is so important because in the statistic on the right-hand side, nearly 14% of US hospitalized Medicare beneficiaries experience adverse events resulting in prolonged hospital stays, permanent harm and life-threatening intervention or in some cases, events lead to death. 44% of those events are considered preventable and the cost associated with these preventable adverse events is over $118 million. So it's really a very important statement on the business case for quality and safety. We have on the next slide, Hillary, we provide you with a list. These are the category areas of the reportable event types. The link at the top is a link directly to the National Quality Forum and a listing of the events themselves but they are categorized in these seven areas of surgical or invasive procedure events, product or device events, patient protection events, care management events, environmental events, radiologic events and potential criminal events. So the way our performance looks here in Vermont, Hillary, if you wanna jump to the next slide, over the course of these 10 years, VPQHC has reviewed 436 serious reports and reportable events, which is just a very substantial and valuable process. And we can take the information learned from these reviews, share those through our communication networks so that again, the lessons learned are passed along to disseminate best practice and eliminate the possibilities or the likelihood of those events occurring somewhere else. So that's a great number and it has been a great effort over these 10 years. The next slide shows you where those events fall in terms of those seven categories. The largest area is care management events that compiles events like pressure ulcers, falls, medication errors, labor and delivery events. And then that category is followed by the much smaller surgical events category. Hillary, next slide. So this is the reporting system since its inception back originally in 2008 and you see a dramatic increase in reporting following calendar year 2011 when the National Quality Forum dramatically increased the number of expanded the list of the serious reportable events. And as a result of that VPQHC embarked on an extensive education program with hospitals that increased the hospital event report submission. And through that educational process we really developed terrific working relationships with our hospital partners that instilled the confidence in this reporting system and VPQHC as a resource to continue improving and reporting on these serious reportable events. So next slide, there we go. This is a screenshot of the annual summary of the patient safety event reporting system in Vermont. This is the 2019 calendar year report that's currently posted on the VDH website. The link is provided at the top of the slide. This will be updated with the 2020 analysis once we've completed that later this spring. But this is this information in this report is available to the public through the VDH website. And if we go to the next slide, Hilary. We also conduct a very similar process with the Vermont Department of Corrections to conduct independent case reviews of serious safety events occurring for incarcerated individuals. We conduct a similar review of the causal analysis and corrective action plans to ensure a thorough and credible analysis was conducted internally and to where we see the opportunity to challenge the partners in Department of Corrections to look at from a systems perspective, both in terms of the patient safety and the Department of Corrections reviews. These are non punitive approaches, but we want to look at systems level fixes to ensure that this type of event won't happen again on the next shift or to the next patient or next individual that encounters the health system. So we in both cases also look to review that compliance with in the case of the Department of Corrections, the National Commission of Correction Health Standards are adhered to and similarly in our hospital reviews as well. We look to have a consistent level of clinical standards reviewed in both situations. So next project and review on next slide, Hilary. And maybe what I'll do is transfer this description over to Hilary. She's been working on this for many, many years with our good partners at the State Office of Rural Health and can speak with great expertise to the next contract and program. Sure. So at this slide is about highlights our work under the Medicare Beneficiary Quality Improvement Project. As Kathy mentioned, VPQ is a subcontractor to the Vermont Department of Health for this work. It's done under the Rural Hospital Flexibility Grant or the Flex Program. The purpose of the program is to improve the quality of care in critical access hospitals by increasing the healthcare quality data reporting and driving improvement projects based on the data. This program allows individual hospitals to look at their own data, measure their outcomes against other critical access hospitals and partner with other hospitals in the state around quality improvement initiatives to improve outcomes and provide the highest quality of care to each and every one of their patients. In Vermont, I'm happy to report that the majority of critical access hospitals have historically participated in this program and it's entire voluntary. So it just shows their commitment to this work. Through the VPQ's role, we provide educational programs to support improvement initiatives and disseminate resources to the Mbequip Network. And we also provide comparative performance data to the hospitals. On the next slide, this includes a list of the measures that are under the Mbequip program. These measures have been deemed by a national committee to be role relevant and to be able to withstand small volumes. And what's so important about this measure set is that the majority of these measures align with other quality reporting programs. And alignment and coordination are so key for not overwhelming hospitals and to be able to allow hospitals the capacity to work on focused improvement where it's needed the most. So VPQHC provides comparative data to the hospitals through this program as mentioned on a quarterly basis. We feedback the data on all of the measures that the hospitals are reporting under the Mbequip program. In the following slides, you'll see a few snapshots of some of the reports that we provide the hospitals with and it's all just examples. It's not actual data from the hospitals. But the first is a comparative dashboard. This is a snapshot in time of the hospital's performance and shows all of the critical access hospitals in Vermont and how they stand in relation to one another and in relation to national benchmarks. On this dashboard, Green indicates they are meeting or exceeding the national benchmark. Yellow is within 2% below the national benchmark and red is greater than 2% below the national benchmark. So here the hospitals can see how they're performing in relation to their national peers, but also their peers here in Vermont. And having something like this really supports networking among the hospitals. If there's a hospital that's doing really well on a measure, their colleagues can reach out to ask how they got there and to see if they have any policies, procedures and tools that can be shared. And this is all in a non punitive improvement focused manner. And the next couple of slides just show some other examples of how we prepare the data for the hospitals. This shows individual hospitals' performance over time on communication about medicines and shows the benchmark as the national average. Sometimes we change that based on the hospital's preference to the 90th percentile. What's nice about the MBQIP program though is that there are also critical access hospitals specific benchmarks, which are really important because we know that critical access hospitals face are unique to larger hospitals in many ways. And presenting the data this way can help hospitals hone in on where they wanna focus. And also just in several instances just shows them how well they're performing on so many of these measures. So a couple of other slides just demonstrating a few other metrics under this program. All right, back to you, Kathy. Okay, so on this slide you may think that we've just ordered up a bowl of alphabet soup with N-quick, H-quick, and E-quick. And one of the other focus areas under our 94-16 contract is called QI coordination. And it's an important activity that VPQHC participates in along with other quality partners, the Blueprint for Health, OneCare Vermont that kind of helps us to align and communicate and kind of figure out, keep everything straight under these alphabet soup categories. So to walk through this fairly quickly, N-quick is the new, the revised CMS Quality Improvement Program that traditionally had directed improvement efforts to Medicare beneficiaries across the country. It is now called the National Quality Improvement and Innovation Contract. And under this contract, 58 primes across the country are awarded task orders to administer different activities. Again, that focus on improvement of quality activities for Medicare beneficiaries. The H-quick is the hospital quality improvement contract and task order three. And currently, VPQHC and VAWS are partners along with six other Eastern States in the Eastern States Quality Improvement Collaborative or E-quick that is focused on the task order three activities of reducing harm and improving patient safety and hospital quality improvements. This program requires significant data submission on standardized metrics that will then aggregate performance data and produce benchmarks for the recruited hospitals. We are very fortunate that VITAL is getting involved and engaged with this work and is developing some resource to provide a comprehensive data submission for the data element requirements on behalf of the Vermont hospitals that will virtually eliminate the reporting burden that our hospitals would have to feel through this effort, through the task order three initiative. And this is one of the envisioned purposes of the Health Information Exchange and we're just so thrilled that VITAL is listening to us and hearing and moving forward with this possibility. And to date, we have seven Vermont hospitals recruited and continue to have additional conversations hoping to recruit a few more. So, Hilary, on the next slide, what we have is a graphic of everything that I just explained. We've tried to go with the philosophy that a picture paints a picture of a thousand words. Everything I just explained is kind of represented on this graphic that's available on our website. It's a little unusual to try to communicate the federal initiatives, but we've done our best job to try to capture the information and keep everyone informed. On the next slide is just some brief picture of the clinical focus areas that will be addressed by the Eastern Quality Improvement Collaborative. Many of these are very important to our hospitals. We have some opportunities for improvement and we have some best practice to contribute to the larger collaborative initiatives. Through this work, we'll be able to deliver some very valuable resources to our local hospitals and continue the work that we've so nicely in with all the work that our hospitals do all day, every day in the areas of patient safety and harm reduction. So we're very excited about moving forward with this work and our expanded partnerships in the region. So on the next slide, I'm gonna ask Hillary to provide you with an overview of this topic. Again, an area she's very familiar with. I do also wanna just mention that we have also partnered for the EQUIP work with the VAWS Network Services Organization, which is helping immensely with the data lift for the hospitals as well. So moving on to this slide though, another project VPQ carries out is the Independent Provider Training Project, which aims to improve the quality of suicide specific treatment in Vermont. This work is supported through independent donor funding. Again, the data is what drove us to focus on this topic. As we know in Vermont, the rate of suicide is higher than average and growing faster than the national average. We also try to do our part and row in the same direction in recognizing that this is an area of focus for the all payer model. This work is how VPQHC saw it could work towards moving the needle on this metric in a way that's complementary and coordinated with everything else that's going on in the state. There are three main pillars to this project. The first is a survey of independent mental health providers in Vermont. In 2019, we surveyed 1,940 independent mental health providers to assess their comfort and competence in assessing and treating patients with suicidal thoughts. You can see the questions that are included in this survey on the slide. The second pillar is training. We are able to offer those providers that want to improve their skills in this area, training at a significantly reduced cost. We partner with an organization to provide what is called CAMHS training, which stands for collaborative assessment and collaborative assessment and management of suicidality. CAMHS is an evidence-based therapeutic framework, which is internationally recognized as a top tier suicide specific assessment and treatment intervention. And the third pillar includes work that VPQHC has done to put together a list of independent mental health providers that have suicide-specific training. This list can be used to support appropriate transitions of care. For example, we provide it to the care management directors at the hospital so they can use it when needed when they're looking to discharge patients. It's also available on our website. And this work is led by Mary McGuigan, our QI specialist at the organization and she's really done some amazing things under this program. All right, let's see. Okay, back to you, Kathy. Okay. On the next slide and this may be familiar to you, we just recently concluded the analysis ready data set report. And we're just so happy to collaborate with the A team at the Green Mountain Care Board. And while this content was maybe not necessarily in our wheelhouse with VPQHC as the experts, we subcontracted with Steve Capell and David Healy. And certainly the process of gathering the information and producing this report is an area of competency for our organization. We conducted a review of the previous efforts and conducted stakeholder interviews with valued partners to understand how the VPQHC data set could be redesigned to be very useful and valuable for analysis for organizations just like VPQHC where we don't have a computer program or PhD on site to be able to navigate the complexities of a data set like V-Cures, but that would be able to give us some basic access and move forward in our continuing search to conduct data analysis to understand and improve the healthcare delivery system here in Vermont. So it was a great opportunity for us to collaborate with Green Mountain Care Board. Then as we go into the next slide, this was our most recent and just recently concluded activity that was funded through the coronavirus relief funding and allocation from the legislature for our connectivity cares package. And back in October, Hilary, you can move to the next slide. We sent out eligibility survey and recruitment flyer information. And this survey was posted for nine days back in October. And only in the period of these nine days that the survey was available, there was an identified need for 1,900 digital devices and over 500 Wi-Fi boosters for organizations serving vulnerable Vermonters. We can only imagine what could happen if this survey were available for a longer period of time. But as our reach, Hilary, you can move to the next slide. We were able to partner with 58 diverse organizations across the state located in all 14 counties that served such diverse groups as assisted living and low income housing, FQHCs, homeless shelters, hospitals, private practices, mental health counseling centers, and so many others. This program was just fantastic in distributing apparently much needed equipment to be able to maintain care and treatment through the pandemic health emergency. Hilary, if you move to the next slides, we have a series of photographs of the equipment being received and cataloged and then reassembled into our literally the connectivity care package and then the distribution process through using a Green Mountain Messenger to distribute all the equipment across the state. And then we've been just so blessed with some of the testimonials and feedback that we've received from these new partners and new relationships that we've been able to form up and maybe just take a moment to read some of these. Thank you for sending along the iPads and what great instructions. I love them already and have two guests already signed up for meetings this week. We know in one of the organizations, I believe it was one of the SASH sites, they received equipment on a Monday and had appointments scheduled for two days later on Wednesday. So this was a very beneficial program and beneficial to Vermonters that were impacted by the public health emergency. And then I think this is my favorite, the testimonial. This is so wonderful. This is going to change my life. So again, we just appreciated all the great feedback that we received and the impact and reach of this program is through final survey, site evaluation surveys that provided estimates for the use of this equipment that each device could potentially reach seven people. Some are being given directly to patients, others are being shared in congregate living settings and then others are set up as a loaner program that get checked out and for use for a designated period of time and then come back and are redistributed to another user and benefit. So those are our current major funding programs. What I'd like to do now is transition to some of the activities we've undertaken and how we feel this delivers value for our stakeholders. We have some several recent and very valuable to us examples of this work and our connections. So Hillary, you're the most familiar with the recent audio only telemedicine clinical quality speaker series and report. So if you'd like to dive into those details that would be terrific. Sure, so here we just highlighted a project that VPQHC recently completed alongside its statewide telehealth work group. Some of you may know that the Vermont legislature asked the Department of Financial Regulation to convene a work group to determine whether parity reimbursement should continue beyond the public health emergency for audio only telemedicine. And as DFR began meeting with its work group, it became clear that there were a couple of different conversations happening. One was reimbursement focused and one was quality focused. So DFR approached VPQHC to see if we could lead the healthcare quality discussion with its statewide telehealth work group which led us to this work. VPQHC was happy to take it up. We lined up a series of local, regional and national subject matter experts in healthcare quality and telehealth to come and speak to the work group. And the product of this work was a report out on our process and recommendations and along with the background of how we arrived at this project. I wanna make clear that audio only telemedicine refers to synchronous telephone-based visits with a provider that replace an equivalent in-person visit. I'll give you a link to the report and I've copied our recommendations in the slides that after this one, but I won't go in too much into detail because I know time is tight. But I will say that consensus was there was a recognition that audio only telemedicine is not a silver bullet for achieving equitable access to healthcare but that it's a step in the right direction under the current conditions of our healthcare delivery system and fee-for-service payments and in a world where the digital divide exists. And the work group consensus was that we need to use every tool available to us to ensure that patients get a measure of care when they need it and where they need it. But as we heard from many of the subject matter experts, this is new-ish territory in the sense that an audio only visit would replace an in-person visit and not just providing some touching base quickly with your provider over the phone. And the group agreed that there were some measures that we could take to ensure that patient safety and quality were safeguarded. So those are outlined in these slides and you can refer to them if you're interested. But I will say I really liked one of the quotes of one of our subject matter experts, Jud Hollander of Thomas Jefferson University said, quality care is quality care, whether it's delivered on the first floor of a building or the fifth. So just to keep that in mind when thinking about telehealth and healthcare quality. And I will just say quickly our recommendation centered on healthcare quality measurement, monitoring and evaluation, patient engagement and empowerment and provider education and training. So moving through, we'll try to get through our last couple of slides fairly quickly here so that there's plenty of time for Q&A. This is another example of a statewide initiative that brought together many community partners looking at the Vermont performance on the follow-up for hospitalization, HEDIS measure. This is a report that VPQ produced as a result of a statewide meeting that we facilitated on the continuity of care following hospitalization for mental health to help improve the transition and warm handoff from the inpatient setting to continuing care and treatment based in the community. So many good policy objectives and opportunities were captured in the brainstorming activity. And this resource is also available on our website as well. And the next slide provides you with a little more detail of the partnership. And Hilary, if you wanna give a quick overview of this because this is very important. Sure, so under the statewide telehealth workgroup at the start of the pandemic, we started offering twice weekly telehealth open office hours and trainings in partnership with the Northeast Telehealth Resource Center and Bi-State Primary Care Association. I've included the topics that we've addressed on the next slide, but this data point just shows the majority of providers were not providing telehealth services prior to the pandemic and everybody had to pivot quite quickly overnight to set up services so patients could maintain access to their care. And here are the themes that we've addressed. Most have centered on workflow development and analysis, data collection, patient engagement, clinical best practices and so on. I do wanna emphasize here, Todd Young, the Network Director of Telehealth Services and Sarah Kessler, Telehealth Program Strategist at the University of Vermont Health Network have been invaluable to this work and have lent their time and expertise for free to really help providers across the state set up their telehealth services. So let's see what's next. Oh, this is another topic that's near dear to our hearts at VPQ again, driven by the data as we've seen that communities of color have been disproportionately affected by the pandemic and that the time is right to really be focusing on and drive health equity initiatives. We offered a training back in the summer and we have more health equity trainings coming up and there's been significant interest in this work. And to close out, another topic that is important to VPQHC is women in healthcare leadership. Nationally, women only hold 13% of CEO positions in hospitals and 30% of C-suite positions despite making up 80% of the buying decisions in healthcare, 65% of healthcare workers being women. So we convened a panel at the VAWS annual meeting to hear from Vermont women healthcare leaders about their journeys, experiences and lessons learned. We also had great partnership from Tiffany Bloomley from Change the Story Vermont who led a facilitated discussion. It was a truly inspirational couple of hours and we're very thankful to the Hospital Association for their support and encouragement of this session and important conversation. So hopefully everybody's still awake. I think that was our last slide. It was indeed a very robust presentation. I'm tired just going through the, but I'll pass it to you. So to wrap up with some final thoughts, this is our VPQHC team. We have 7.5 FTEs that do the lift on all the work that you just heard about. There's only two faces missing from this collage but we work extremely well as a very dedicated group of professionals. And I think I'll speak for the entire group and say we really don't work every day. We bring our passion and so it doesn't feel like work. We are putting our best efforts towards activities that we believe in and it doesn't feel like work to us. Probably the best compliment ever came from Dr. George Blike. The recently retired chief quality and value officer at Dartmouth Hitchcock who stated as he was retiring as our board chair that VPQHC punches above its weight class. And I just, I have to agree everyone works so hard. And just a final thought that the lessons we've learned on our journey are that partnership, collaboration, local knowledge and relationships are key and alignment and coordination of activities are essential. And just a final thought that as Green Mountain Care Board is moving towards the hospital budget season, we'd love to collaborate and support provides support to develop a dashboard of key metrics to monitor as hospitals transition into value-based payment arrangements. And we can help develop a process for the quality portion of the hospital budget reviews that can connect the community health needs assessment results to action plans and make those findings come alive. And then finally, we want to increase our communications with the Green Mountain Care Board about hospital quality initiatives that happen all day every day throughout our Vermont hospitals. So I'm gonna leave you with that as a final thought and then Chair Mullen, we're happy to entertain questions. Well, thank you so much, Kathy and Hilary. We'll start with the board and I'll go in alphabetical order. So I'll call on board member Holmes first, Jessica. Great, well, thank you both for coming. I so appreciate the time that you took to pull together this presentation. It's clear there's a lot of great work here. Maybe I should say lots of great passion here and what you do. And I look forward to the area, the final slide of the areas for collaboration and synergies really helpful. I do have a couple of questions and it's so, I've been on the board for six years and we've interacted sporadically over the years but we've never had a comprehensive full blown presentation. So I learned a lot today about what you do. So I really appreciated that. One of the things that struck me is it seems as if most of the assessment and the measurement of quality in terms of the reporting that's done the site visits that are done are really done at hospitals. And I was wondering what role VPQ plays in the rest of the care continuum in terms of measuring assessing site visits for quality that's delivered elsewhere. Sure, Jessica, as some of our presentation showed we have a partnership with Department of Corrections and we've done that work for a number of... Well, go ahead. Right, yeah. And nursing homes, long-term care, home care have a system of supports that we connect to periodically but they're well supported in their efforts to improve quality initiatives. We are always a resource to help develop talent and share educational opportunities with the other components of the continuum but specifically with skilled nursing facilities, nursing homes, the more regional QIO organization has great programs and supports and that's where we also do that QI coordination work but we also participate in the blueprint executive committee meetings and have routine communications with one care per month. So we work across the continuum. We would also love to develop more partnerships and relationships with Vermont care partners. And I think our work with the independent mental health providers is a step in that direction for sure. Got it. Okay, that's helpful. And I'm thinking about, we've heard from hospitals and other, as it relates to the all-paramodal or one care or other types of programs and initiatives that they get a lot of data. They have so much data sent to them and there's a lot of reporting that goes in the other direction but there's a lot of data and analysis that gets sent down to the hospitals and one of the things I've heard from some of the hospital leadership is that so much data, it's not a shortage of data, it's a shortage of resources to be able to implement the changes that would be required. And I'm wondering, how do you think about that? It's one thing to showcase some of the areas where there might be opportunity, but then what's the next step and how do you think about working with the hospitals to make the changes that are needed to get those quality metrics going in the better direction, going in the green, out of the red? Absolutely, absolutely. And I absolutely agree there's so much data but there's kind of a shortage of information. And I think that's where an organization like VPQHC can help in that process of taking the data and conducting the analysis, presenting it in a comparative format so that the hospital or any other organization can then see themselves in the pack, like where they fall against a peer group and against a benchmark and then have that meaningful discussion about, well, what specifically are your areas for improvement and just help convert that pile of data into meaningful information. Yeah. And I imagine that's where the peer network helps a bit as well. Absolutely. One of the statutory requirements of the HRAP is for us to be thinking about identifying and quantifying over-utilization and under-utilization. And both obviously have huge impacts on the quality of care delivered. So I'm wondering in your, with your expertise or your experience, how would you help us or what direction might you send us in to think about how would you measure over-utilization and under-utilization as we need to in our HRAP analysis? I think that's kind of what they call the Goldilocks position, finding the exact right number for volume or utilization. And there's often pairings of metrics that the over-under can be balanced and always, always having what I would call the mindful discussion of what unintended consequences could be from too much restriction on certain resources or capacities so that there is not an unintended, unintended consequence of driving further for care and driving right past a facility that would be able to deliver the right care. I think also understanding ambulatory sensitive conditions and potentially preventable admissions, but really understanding so that those unintended consequences can be avoided. Well, if you have a list of those metrics or please send them our way, that would be really helpful. And we've thought about, and I think we're using some of the ambulatory care sensitive conditions and the preventable admissions, but over-utilization, that would be helpful too. There's some areas like choosing wisely has some metrics, but I would love, if you've thought about this, to send it our way. My last question is, I thought that was an interesting statistic about the 14% of Medicare beneficiaries who experience adverse events. And then if you do the deeper dive, it's about 6% of overall Medicare beneficiaries who have something as preventable. I'm wondering, has VPQHC done any analysis of Vermont? What is the similar metric or proportion in Vermont of Medicare beneficiaries who experience adverse events or preventable adverse events? Do we know that? I think we can get some of that data through our QIO partners. And yes, we would love to start diving into that. And I think those are some of the areas in the hospital quality improvement contract that we'll be able to produce that information and have some meaningful conversations. Would that go in the dashboard that you were suggesting? It absolutely could. That sounds great. Okay, those are my questions. Thank you so very, very much. I appreciated it. Thank you for the opportunity, Jessica. Thanks, Jess. Now we'll move to Robin. Thank you. Thanks, Kathy. Thanks, Hilary, for giving us an update. It was really interesting to hear how things have evolved on the telehealth front for me since I was an area I looked at in a lot of depth with the World Health Services Task Force. My question was around the Medicare quality improvement initiatives and whether you've thought about or looked at already how those measures may be consistent with or not if they're not the all-pair model metrics. Obviously, certainly at the all-pair model level, we were shooting to have a fewer number of measures and there's certainly more in the Medicare space that's included in your slides. But I was just curious about your thoughts on that. So for me, Robin, and that's a great question. Absolutely. And I think about that a lot because the MVQIP measures are really tailored to be rural relevant and they focus on those processes that the small hospitals have to fulfill and how the metrics that are big sized for community-sized and academic medical centers just simply don't fit. So population-based measures also for an ACO organization are also probably not the right fit for the critical access hospitals but how they can all play their role in a systemic view of system-wide care delivery and how is everybody executing their piece of the process. I think that's a good way to look at how the metrics are used and kind of how they're put together to provide an overall system performance picture. Thank you. I was also curious, one area that we frequently hear as I'm sure you do as well is related to the administrative burden of measurement and data collection. And I think there have been some great strides in terms of using vital or other entities to help with that administrative burden. Do you think that we as a state have more work to do in terms of aligning metrics? We did a lot of work prior to the all-pair model around trying to ensure that we were streamlining as much as possible collectively as a state but certainly there are some metrics that are more federally driven and I'm wondering if there might be any opportunities for further streamlining even if it involved federal partners, for example, perhaps when we are talking about the next iteration of an all-pair model agreement. I'm robbing to be totally honest, I always see that there's opportunity for further alignment and harmonizations across programs where that's possible to the greatest extent possible. I think Vermont is certainly moving in that direction and has achieved some good progress there. There's always more to be gained with further alignment. Great. Well, thank you very much. Those were my couple of questions. Thank you, Robin. Tom. Well, thank you for this. It's overwhelming almost listening to the breadth of your activities not only in the moment, but over time. I have some vague reelection when the VPQHC was formed in the early 90s. And as a kind of a follower, I think, from the healthcare single payer fights back in the early 90s. But so my questions would kind of follow in line with Robin's presentation and Jess's as well. The, I guess one question I would have is over the short term over the next two years, what would you like to see the Green Mountain Care Board do better from a data-driven perspective? What do you think we can do better? And what would you like to, what are the two or three things that you would like to see us do better? So, I would love to see the Cures be able to step up almost nationally as a really excellent top-notch all-payer claims database. And I think the Green Mountain Care Board is well along that path to move that forward. I look really, really look forward to the integration of clinical data into vital and any role that Green Mountain Care Board can take in supporting that both policy and procedural process towards that, that would be another step in the right direction. I think in terms of a longer term vision, I would just love organizations like VPQHC and our hospital organizations and others, Vermont Care Partners, Healthcare Advocates Office, for all of us be able to go to the data well, dip our bucket in, easily get the data that we need to do analysis and convert that to information that then informs policy improvement initiatives and resource allocation, that would be fantastic. It certainly would, and it leads into my second question that as I was listening to you, I was thinking of all the other data sources that I've encountered in my three-year journey here. And you think about our own A-team, which is great. The Healthcare Advocate has some folks that like to crunch numbers. Diva has its own data, the Department of Health as well. You folks, Vaz, insurers, Vital, and there are so many of them. And so the point that you were making near the end about alignment and coordination of activities is so important because sifting through it all is and finding the true story or the true stories is very difficult. So I'm wondering if as someone familiar with all these entities, whether or not you folks would be willing to try to write a four or five page paper about how we might get these bumper cars from less bumping and more using the data to address, to define problems and to address problems. Because I think there's a lot of data out there. And just like you just said, people would be helpful to be able to say, here's the dashboard, here's my bucket, this is what I need and help answer questions in a timely manner rather than at least in my experience, sometimes hunting and pecking around. And I'm not sure that I'm a cherry picking or hunting and pecking sometimes. So it would just be helpful because there is all this data out there. Every one of these entities does a lot of number crunching and there's some on the spot coordination where people need help and one entity helps another. But it would be nice to have somebody, I think kind of think through, how do you glue these together and truly achieve the alignment and coordination that I think Jess's questions and Robin's questions, we're searching for. Well, Tom, I think it would be very willing to take that on. But judging by our presentation this afternoon, it may be kind of hard for us to keep that to a four or five page paper, but we would definitely welcome the opportunity to really, as you described, think through how to glue that all together. Well, that would be a wonderful result and hopefully we'd send the snowball rolling down the hill. So that was my observations were right in line with Robin's and Jess's in terms of that regard and just my own personal experience, trying to find helpful information that is well-grounded and foundational to help shape decisions that are the best they can be. Thank you. Oh, very happy to have you, Tom. Thank you, Tom, Maureen. First, thank you very much for the presentation. It was really informative. And I think you should come before the Green Mountain Care Board more at work with us. I definitely think the punch above your weight quote was a good one because you guys do produce a lot of information. Most of the questions I had were asked, but I have a couple on, when you looked at your P&L, I always have to go to the financials, but when you looked at your P&L and your revised 21, where your expenses are cut in half, so they were 7.26 going to 3.67 for personnel expenses. Is that where you put the PPP loan or I just wondered how you got? Yes, and we retracted to a certain extent over this period, but we had some program deliverables in our contracts that we were not able to execute on because we couldn't conduct site visits on the hospital campuses. Oh, okay. That impacted two of our contracts. Okay, but did you put the PPP in the revenue line? I would have put the PPP in the revenue line. It doesn't matter, but your expenses were cut. I didn't know if you were offsetting that. Yeah, I'd have to double check with my director of finance and we've only just today gotten approval of our PPP application. So we've been absolutely thrilled with that information that really substantially helps the organization, but yeah, we jumped through all those flaming hoops and we would not put that in an inappropriate category, for sure. Okay, and I definitely think for the hospital budgets and being able to produce dashboards, particularly for the quality pieces would be very helpful. And when you look at the information you put together on the preventable events and the 118 million, what time period was that quantity for? So you had 118 million was what you quoted for preventable adverse events in the hospitals. So that's a national statistic that came out of the Center for Medicare and Medicaid Services. I'd have to go back to the source to double check the timeframe for that, for those specific numbers. Okay, okay. Yeah, bringing those to our hospitals, right? And the charts that you do and trying to track and quantify if that's, and I know you did do some charts on that and the number of incidences, but if that's increasing, decreasing, how we can learn from the data that you have and translate that to better quality, lower cost healthcare would be really helpful. So that was one area. Other than that, thank you. This was very informative presentation. Terrific work for you. Yeah. So great, at this point in time, I'm gonna open it up for public comment for questions. Are there members of the public who wish to comment on today's presentation? Is there any member of the public who wishes to comment on today's presentation? Seeing and hearing none. Kathy, Hilary, it's been a fascinating afternoon. You guys are doing a lot and keep punching above that weight class. Well, we'll do. Thank you so much, Chairman. You're welcome. Board members, is there any old business to come before the board? Hearing none, is there any new business to come before the board? Hearing none, is there a motion to adjourn? So moved. Second. It's been moved and seconded to adjourn. All those in favor, signify by saying aye. Aye. Those opposed, signify by saying nay. Thank you, everyone. Have a great rest of the day. Thank you, Kathy. Thank you, Hilary. Thank you. Thank you all.