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Reality Check in a Time of Uncertainty

Change brings opportunity. And judging from the amount of change underway in Colorado’s health care community right now, we’ve got lots of opportunity! Nonprofit organizations—including CIVHC—and state agencies are undergoing leadership transitions. Foundations are reconsidering their funding approaches. Colorado’s State health Innovation Plan lays out an ambitious, multi-year agenda for health system transformation.

At the same time, we’re witnessing rapid change in health care delivery, payment and coverage in our state. Hospitals are merging with one another and creating vertically integrated systems with physicians. Medicaid and commercial health plans are experimenting with new outcomes-based payment models. More Coloradans are gaining coverage through Medicaid and private health insurance.

Along with these opportunities comes uncertainty. How do we implement a shared vision of health system transformation? How do we guard against the mistakes of old-school gatekeeper capitation payment and failed physician-hospital organizations? How do we ensure that coverage translates into access to care for our newly-insured citizens? In light of the challenges and changes in implementing the Affordable Care Act, will it fulfill its promise?

At this time of uncertainty, I return to the 208 Commission’s vision for an “Improving Value in Health Care Authority”: a multi-stakeholder organization dedicated to “fundamentally realign(ing) incentives in the Colorado health care system in order to reduce costs and improve outcomes, and identify other means of containing systemic cost drivers.”

That’s a pretty important niche to occupy, and CIVHC is proud to fill it. But let’s be clear: This mission isn’t innocuous. It can be threatening to those who thrive in the current system. Yet it is essential to have an organization with the focus, the tools and the resources to objectively push for change, without a direct stake in the outcome.

CIVHC acts as a multi-stakeholder convener, but we are not neutral. We have an advocacy agenda, developed in collaboration with the many stakeholders who helped establish CIVHC’s direction: to spur the development of coordinated systems of care and speed the movement away from paying for volume to paying for value, using data to track costs, monitor performance and highlight opportunities for change. We are proud of that agenda and believe that, now more than ever, it is an essential one for our state.

About the Author: Edie Sonn is CIVHC's Interim CEO and Vice President of Strategic Initiatives. Contact her at

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