Vermont Performance Reporting Tools Promote Accountability and Improvement

Government officials, community leaders, and other stakeholders can track data on the health of Vermont residents through the state Department of Health’s Healthy Vermonters 2020 website. Intended to promote the well-being of state residents, the site includes baseline data from 2010 and 2020 targets that were part of a 10-year state health assessment plan.

The approach is based on the federal Healthy People 2020 framework run by the U.S. Department of Health and Human Services. That project provided a comprehensive set of 10-year national goals and objectives for improving the health of all Americans.

Healthy Vermonters includes over 100 public health indicators collected and analyzed by the Center for Health Statistics, a team of 35 analysts in the state Department of Health. State experts then work with program leaders to review the indicators and outcome data to determine whether public health services are achieving desired results. 

The website presents the analyses through two interactive products: the public health data explorer and performance scorecards that look at progress toward specific public health outcomes. These allow stakeholders—including the department staff, the state’s 12 health district offices and their partners in delivering health services, and the public—to answer questions about the health of state residents and the effectiveness of various efforts.

How healthy are state residents?

The public health data explorer shows how Vermont fares across 122 indicators. It features trend lines showing progress over time, as well as maps and graphs comparing data at the county, health district, and hospital service area levels.  The state does not have county governments. Instead, the district offices work with cities and towns, nonprofit organizations, schools, employers, medical offices, and other partners to deliver critical programs and services to Vermonters.

The Center for Health Statistics collects  these data and populates them into publicly available community profiles that show how each of the health districts is faring across all measures. Information is displayed over time and color-coded to show how each district compares with the statewide average. An infrastructure analyst from the center works with each of the district health offices to identify specific data needs, holding in-person meetings once a year and telephone-based trainings three or four times a year.

The community profiles play a key role in helping the district office staff identify critical needs.  For example, 2017 data showed that Windham County worse than the state average in a variety of nutrition-related indicators, including the percentage of adolescents who do not eat fruits and vegetables every day.  So the Brattleboro District Office worked with schools, a cafeteria services provider, and a community nonprofit to obtain a grant to make healthy lunches more accessible to area students.  The Healthy Vermonters data point provided key evidence that this resource was needed in the school community. The Health Department’s district offices are a primary user of the community profiles, which also provide critical data and insights for other community organizations and hospital community health needs assessments working to identify areas of need.

A look at how state efforts are faring

The Healthy Vermonters performance scorecards use statewide population and program-level performance data to show how well the state is doing compared with desired outcomes over time. Scorecards show progress on select indicators by displaying a target—set at the program level—and the trend relative to the target.

The scorecard includes a “story behind the curve” narrative that describes what is happening to bend the curve. For example, the state and federal governments collect and report quarterly data on the number of Vermont residents at risk of diabetes who complete the National Diabetes Prevention Program. When parts of the program were forced offline for several months in 2017 because of administrative changes, the state trend dipped from 76 people per quarter to 10 to zero but bounced back to 107 in 2018 when the program went back online. The data, which can be viewed in line or bar graph formats, show the decline in program completers, and the subsequent improvement. The division staff used the story behind the curve to explain the data and demonstrate the effectiveness of the program in reaching its intended population and the value of building in time for administrative changes.

Statewide, the staff of the department and other agencies use the data trends to inform their actions. For example, the Department of Health’s Division of Alcohol and Drug Abuse Programs works with the Department of Vermont Health Access (Vermont’s Medicaid agency) to improve access to substance abuse treatment. These efforts have been informed by a performance measure linked to how quickly adults or adolescents experiencing new episodes of diagnosed dependence start substance use disorder treatment.

The measure assesses how many start treatment within 14 days—the state’s target is at least 50 percent of those who receive such a diagnosis. The state has made progress in recent years toward that through efforts to better coordinate care between the organization that diagnosed the disorder and the one that provides treatment.

The state agencies have worked with community partners to increase access to treatment and identify strategies to ensure its initiation. Currently, for example, they are working to incorporate the use of telehealth options to improve care.

The ongoing communication, engagement, and educational activities promoting care coordination have helped bend the curve toward the target:  The percentage rose from 44 percent starting treatment within 14 days in 2014 to 47 percent in 2018.

The scorecards have become such an effective tool that they are used to inform state legislators about Department of Health priorities. According to Heidi Klein, the department’s director of planning, “The scorecards offer an easy way to say: ‘Here is what we know about the health of Vermonters, here are the areas where we need to focus, and these are the policy investments that we think the state needs to make.’”

For more information:

• Vermont Department of Health Healthy Vermonters 2020 and Health Status Reports.
• Vermont Department of Health public health data explorer.
• Vermont Department of Health Healthy Vermonters performance scorecards.
• U.S. Office of Disease Prevention and Health Promotion, Healthy People 2020.

Sara Dube is the director and Priya Singh is a senior associate with the Pew-MacArthur Results First Initiative.