RUTLAND, Vt. -- Kirk Dufty doesn't have to rely on patients' hazy memories or take their word for what drugs they're taking when they show up at his emergency room.
In minutes, the doctor can find out whether a man with chest pains has filled the prescription for the anti-clotting medication he's supposed to take or whether a woman complaining about a stomachache is really trying to get more narcotics to feed her drug habit.
The information is available at Rutland Regional Medical Center through a new computerized records system installed as part of the broader health care overhaul Vermont passed in 2006. It helps Dufty do exactly what the overhaul was designed to do statewide: cut costs and provide better medical care to patients.
Vermont has "one of the most innovative models of prevention ... and care coordination in the country," one that could be a guide for Congress as it debates an overhaul to the nation's health care system, says Kenneth Thorpe of the Partnership to Fight Chronic Disease.
Massachusetts' health care overhaul included a costly mandate that nearly every resident have insurance, paid for by employers, insurers and taxpayers.
Covering the uninsured is at the heart of the debate in Washington also as Congress struggles with whether to offer -- and how to pay for -- health care for more than 46 million in the USA without insurance coverage.
The Green Mountain State took a different route. Officials decided they couldn't afford to cover everyone, so they focused on cutting costs and improving care, with the goal of insuring more people. They won over critics in the Legislature and the public by not raising taxes.
Instead, the state persuaded insurance companies and hospitals to kick in. The federal government gave Vermont flexibility in how to spend Medicaid dollars. The only hit to the public: a tax on cigarettes that is 80 cents per pack and a $365 per employee penalty for businesses that don't offer health insurance.
The program is new, and cost-savings results that might draw critics aren't in.
On a national scale, Vermont's model would not meet President Obama's goal of universal coverage. Nevertheless, "I think it's a model that can be replicated around the country," says Gov. Jim Douglas, a Republican who worked with a Democratic Legislature to pass his state's plan. At the White House's request, Douglas has briefed members of the administration and Congress about the plan.
Dennis Smith of the Heritage Foundation, a conservative think tank, says Obama should take a lesson. "Vermont demonstrates that a decentralized, consumer-driven system can expand access and improve quality within current resources," he says.
The state's plan includes:
*The Blueprint for Health, a program aimed at cutting costs and improving care by preventing chronic diseases such as diabetes and getting better treatment to people who have them.
More than 60,000 state residents are participating in pilot programs in Burlington and St. Johnsbury that have been running for about a year.
Paid for by private insurers, Medicaid and the state, the program provides community care teams that work with primary care doctors. The teams include nutritionists, mental health counselors and social workers.
"We're seeing people make major life changes," says Pam Smart, coordinator for the St. Johnsbury team.
She says one young woman with asthma had been going to the ER monthly for a year before she was referred to a community team. Now that woman takes the medications she needs, has stopped smoking and hasn't been to the ER in months.
Overall, visits to emergency rooms -- a major drain on the health care system nationwide -- are down 30% in Vermont.
Jim Hester, director of the Vermont Legislature Commission on Health Care Reform, says the state won't have data on cost savings for a year, "but the early readings we find encouraging."
*Investments in health information technology, including computerized medical records.
The medications history project in Rutland, which allows doctors to see prescriptions filled over six months, hasn't shown cost savings. Dufty is convinced there will be long-term savings because of fewer tests and faster treatment.
The list "gives us a much truer picture" of what's behind the illness or injury that has brought the patient to the emergency room, Dufty says. The data come from insurers, so doctors can get information only on patients who are covered and agree to the computer search. Dufty says 98% of the 35,000 patients his ER serves each year agree.
For the first six months of the program, which started in 2007, the state paid the $3-per-patient bill. Now the hospital pays.
*A new public-private health care plan, Catamount Health, that offers low-cost health insurance to residents on a sliding scale. In 2006, when Vermont's plan was approved, 9.8% of the state's 600,000 residents had no health insurance. Politicians set a goal of reducing that percentage to 4% by 2010. Today, it's at 7.6% .
Doctors urge patience. When it comes to preventing chronic diseases responsible for rising health care costs, "we're not going to see that benefit for five to 10 years," says Joyce Dobbertin, a family doctor in Lyndonville.
"The biggest thing that worries me at the national level," Dufty says, "is that the debate has been about payment reform. We have to figure out how to change care so we can afford it."
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