Legislators press Blueprint for Health presenters on funding, NCQA burden and early mental‑health pilot gains

Melissa Black, chair, convened a March 31 briefing that walked legislators through Vermont’s Blueprint for Health, focusing on community health teams, value‑based payments and outcomes from a $16 million mental‑health integration pilot.

John Soy, executive director of the Blueprint for Health at the Agency of Human Services, outlined the program’s history and structure, saying the Blueprint was codified into statute, expanded statewide and centers on patient‑centered medical homes supported by community health teams that include nurses, social‑work coordinators, behavioral‑health counselors and community health workers. "The Blueprint assigns practices to a health service area" and supports teams "at no cost to patients or providers," Soy said.

Legislators pressed presenters on how the Blueprint is funded and measured. Soy described the program’s multi‑payer per‑member‑per‑month (PMPM) payments — paid by Medicaid and commercial insurers (Medicare participation ended last year) — and an attribution algorithm that looks back at two years of claims to assign patients to practices. He said roughly 293,847 patients were attributed to Blueprint practices under that algorithm and that the program directs payments to practices to support advanced primary care and community health teams.

Panelists highlighted a two‑year, $16 million legislative appropriation to embed mental‑health providers in primary care. "We were able to add more support for mental health, substance use, and social drivers of health and embed those individuals within primary care practices," Soy said. Dr. Addie Armstrong, a Blueprint health‑services researcher, told the committee that early outcomes are promising: "From 2023 to 2024, while non‑Blueprint folks continued going up, Blueprint folks’ ED visits with mental‑health needs went down," suggesting the pilot reduced emergency‑department use among people with behavioral‑health needs.

Members sought detail on how much of the pilot appropriation has been spent and how the extension to a third year was financed. Presenters said some of the originally appropriated funds were unspent due to position vacancies and that they identified funds and federal rural‑health transformation dollars to continue the pilot into FY27; they committed to providing exact expenditure figures for the record.

Lawmakers also questioned program design and potential unintended incentives. Several members pressed whether performance measures that affect payments — for example, hypertension and diabetes control or adolescent well visits — could penalize providers for patients’ choices outside clinical control or encourage gaming of records. Soy said base PMPM payments are meant to underwrite practices’ ability to meet standards, while performance payments are a smaller, outcome‑tied component. He also said the Blueprint is actively reviewing metrics and hopes to streamline measures with insurers to reduce administrative burden.

Members raised concerns about NCQA recognition, which practices must secure to participate fully in the Blueprint. Presenters described NCQA recognition as a "heavy lift" (practices pay NCQA fees and submit documentation) but defended standards as a quality floor. Soy and Armstrong said 124 practices are currently enrolled in the Blueprint (out of an estimated 168 practices), a participation rate they estimate at roughly 65–75 percent, and they signaled S197 (a bill referenced in the briefing) will include language to allow nuanced approaches to broaden participation without dropping quality expectations.

The committee also asked whether government dollars are being used to place workers in for‑profit or private‑equity‑backed opioid‑treatment sites (hubs/spokes). Presenters acknowledged they did not have the number on hand and committed to returning with specific counts and documentation to clarify which spoke sites are operated by private equity‑backed entities and how Blueprint funds are directed.

Presenters made clear the limits of claims data. Armstrong noted that the attribution and outcomes analysis covers roughly 294,000 Vermonters with claims submitted to the state’s reporting systems and that gaps exist where insurers do not submit data; she recommended risk‑adjusted analyses for fair comparisons and pointed to the Blueprint annual report for fuller documentation.

The session closed with presenters promising follow‑up on specific figures (exact pilot expenditures, numbers of spokes operated by private‑equity owners, practice‑level panel counts and payer mixes) and with an assurance that more detailed outcomes and 2025 claims runs will be analyzed and returned to the committee. The briefing did not produce any votes or formal committee actions.