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The Power of Collective Impact

Each year after the Colorado Health Symposium I come away proud of the progress we’ve made in health care in our state and re-energized by the commitment and collaboration of so many Coloradans to achieve true systemic change. Through the efforts of many, a plan of action is coming into focus on ways to solve Colorado’s health care problems. Rising costs, mediocre patient experience, a population getting less healthy, and a near total lack of transparent data that can make a broken system work better plagues our state and country. Many organizations in Colorado are pursuing strategies and engaging in interventions to address specific aspects of the solution. However, if Colorado is going to thrive we need to work faster, smarter and in a more systemic way.

Of all the issues we face, bending the cost curve is the most critical and intractable. At CIVHC we believe that if we are to achieve the Triple Aim of lower cost, better health and higher quality, changes in payment is the first domino that has to fall. CIVHC’s latest inventory of payment and delivery system initiatives demonstrates that many entities in our state are going to great lengths to test and implement solutions to address the shortcomings of our current system. Over 60 initiatives have been identified so far and programs are happening in every corner of the state including Patient-Centered Medical Home (PCMH) programs to coordinate care, care transitions initiatives to reduce readmissions, and payment reform projects to pay for value not volume. However, these efforts individually, while very important, are alone insufficient to achieve the desired overall result for Colorado. Instead, we need a cohesive, coherent strategy to truly transform health care in Colorado.

That brings us to CIVHC’s recently approved strategic plan. One of its conclusions is that we have to find innovative ways to work in Colorado that are outside the traditional approaches of individual organizations working in silos. This concept has been labeled “Collective Impact” by the Stanford Social Innovation Review, and CIVHC’s board adopted many aspects of the change model. The approach starts with the following premise: “Large-scale social change requires broad cross-sector coordination, yet the social sector remains focused on the isolated intervention of individual organizations.” For many of us, both organizations working to change the system and those foundations that are in investing in those efforts, there is great resonance in that premise. There is a sense that just working harder is not the answer - we need to shift the paradigm of how we organize our work and channel our efforts.

As mentioned, CIVHC’s Board of Directors recently adopted a strategic plan that is built around the concepts that are embodied in this Collective Impact model of change. We subscribe to the notion outlined in the model that five things are required to move from silos of initiatives to broad sectored coordination. The key enabling conditions for a Collective Impact approach are in place in Colorado, at least to a certain extent. These include:

  • A common agenda of the Triple Aim +1, where participants in the health care system are developing a shared understanding of the problem and discussing joint approaches to solving it, particularly in the area of payment reform and cost containment.
  • A shared measurement system, for collecting data and managing results to obtain and sustain alignment. This includes the All Payer Claims Database and community dashboard.
  • Mutually reinforcing activities, which are being undertaken by various entities in Colorado. There is an opportunity for better coordination in support of the common agenda.
  • A program to encourage consistent, open communications to build trust, assure mutual objectives and create common motivation is getting underway.
  • An organization to provide backbone support has so far been missing, but CIVHC has the potential to undertake this function.

Over the coming months, CIVHC will be working to further integrate its efforts with the many other organizations focused on transforming Colorado’s health care system with the objective of creating a more aligned and systemic approach to achieving a common agenda. A critical element of success will be our joint ability to engage a much wider constituency across Colorado and build their commitment to a shared vision for health, health care and lower cost. We look forward to uniting our many efforts into a broader framework for achieving meaningful change.

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