Adam Atherly, Ph.D. (Photo: Medical Communications)
A new, three-year $500,000 grant from Systems for Action, a national program office of Robert Wood Johnson Foundation, will allow members of the UVM Center for Health Services Research (CHSR) at the Larner College of Medicine, led by center director and Professor of Medicine Adam Atherly, Ph.D., to explore the effectiveness of community health teams in improving the quality and efficiency of health care delivery.
"Over the past decade there's been a statewide effort to move all primary care to patient-centered medical homes" explains Atherly. "As part of that effort, Vermont started a pilot program and then full implementation of community health teams that were intended to act as liaisons between health care and other patient needs."
Community health teams are composed of nurses, social workers, dieticians, substance abuse counselors, and other roles -- all designed to provide services beyond those typically encountered in the physician office.
"In many cases, a patient's medical problem is linked to underlying behavioral or environmental situations," says Atherly. "it could be an economic problem, for example, where what's really vital for a long-term solution is for that person to be connected to community resources for housing or food. There's no drug or surgery that's going to help that person. That's where community health teams come in."
Vermont's health care funding landscape has been conducive to the fostering of community health teams. Under a 2018 waiver from the Center for Medicare and Medicaid Services, Vermont health care providers have the option to participate in the only “all-payer accountable payer organization” in the nation. This sets the stage for healthcare providers to decouple care delivery from billing concerns.
"This has given health care organizations in Vermont a lot more flexibility," says Atherly. Participating providers are no longer paid to simply provide in-house procedure, but are given the opportunity to look more broadly and holistically at the full range of a patient's needs.
"This has been a complaint people have made for years -- that we were a volume-based health care system, not a values-based one," says Atherly.
But are these new teams having the desired broad-based effect? That's what Atherly's team will study over the course of the next three years. "We've created the incentives that should make the health care system want to use these resources," he says. "And now we'll be trying to figure out if they actually work and keep people healthier."
To do this, researchers will be using community-based focus groups and other surveys, and extensive analysis of de-identified electronic health record and insurance claim data. The CSHR, which Atherly founded in 2018, is well-poised to lead this work, and will also bring in partners, such as Senior Associate Dean for Public Health and Policy Jan Carney, M.D., M.P.H., from across the University.
Atherly has had several past grants from the Robert Wood Johnson Foundation in related areas, and is looking forward to the clarity this work could bring to health care planning nationally.
"If you want to understand whether and how this kind of health care reform is working, understanding the experience of community health teams in Vermont is crucial," he says. "They're out there doing their work with patients, helping people stay healthier. And that's ultimately what we want as a state and a nation."