Blueprint for Health officials tell House Appropriations committee program linked to fewer ER visits, Medicaid remains largest funder

BURLINGTON — Officials from the Blueprint for Health briefed the Vermont House Appropriations Committee on Feb. 28, 2025, saying the statewide, multi‑payer program that funds patient‑centered medical homes and community health teams is associated with fewer emergency department (ED) visits and is funded primarily by Medicaid, with Medicare and commercial insurers also contributing.

The briefing explained how the Blueprint’s core elements — patient‑centered medical homes, multidisciplinary community health teams and specialty initiatives such as the hub‑and‑spoke model for opioid use disorder and the pregnancy‑intention initiative — operate across Vermont practices. John Saroyan, executive director of the Blueprint for Health, told the committee the program is “a multi payer model” and that payments support both practice transformation and locally chosen community health team staff.

The committee heard funding and operational details. Saroyan said most Blueprint dollars come from Medicaid, with Medicare and commercial insurers (Blue Cross Blue Shield of Vermont, Cigna and MVP) also paying into core initiatives; self‑funded employer plans governed by ERISA do not contribute. Saroyan described the program’s monthly per‑member payments (value‑based, prospective payments calculated by insurer attribution) and said a typical small practice’s Blueprint payments can total roughly $4,500 to $5,000 per month. He added that community health teams commonly receive about $50,000 per practice per year to support staff such as care coordinators, counselors and community health workers.

Addie Armstrong, the Blueprint’s data lead, outlined how patients are attributed to practices: insurers apply an algorithm using the prior two years of claims to identify who received most primary care from a given provider. “An insurer will look at the last 2 years of all the claims … and say, okay, Jane went to this doctor 14 times,” Armstrong said, describing the attribution and tie‑breaker process.

On outcomes, the presenters showed analyses comparing Blueprint patients to non‑Blueprint patients. Saroyan said the program’s patients have fewer ED visits: “That saved about 4,500 to 5,000 ED visits last year,” he said. Armstrong added that the difference is statistically significant and reported a p‑value of 0.001 for the comparison, meaning the team judges the result unlikely to be random.

Blueprint staff also reported operational scale: community health teams deliver roughly 300,000–400,000 distinct services or “encounters” per year (defined by the presenters as interventions such as brief counseling or self‑management education, not simple appointment reminders). The Blueprint has expanded initiatives in recent years, including a 2023 one‑time appropriation for a mental‑health‑integration pilot that the presenters said was structured as a two‑year pilot with language to allow it to run three years or until funds are exhausted.

Committee members asked about program vulnerability amid federal Medicaid policy changes and recent Medicaid redetermination. Presenters said the Blueprint’s Medicaid funding is tied to Vermont’s Section 1115 Medicaid waiver work and that reductions in Medicaid enrollments have reduced the Medicaid attribution counts reported for some quarters. Saroyan said there is “a little bit of lag time” when people change insurance, which can temporarily lower attribution counts even if overall access has not fallen.

Members also asked about administration and fund flow. Presenters said that in past years OneCare administered Medicare portions of Blueprint funding and that distribution channels vary by payer; the governor’s recommended budget includes a $10.8 million line item, roughly half of which the presenters said is intended to support Blueprint payments.

The committee did not take formal action during the briefing; members asked for follow‑up on audits, cost comparisons over time, and the program’s exposure to federal policy changes. Saroyan and Armstrong offered to return with further details and data.

The presentation and Q&A underscored two tensions the committee flagged: the Blueprint’s measurable reductions in ED use shown by the presenters’ analysis, and uncertainty about sustainable funding as Medicaid rolls, federal rules and prior administrative arrangements change.