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Putting Our Heads Together

For several months, a very broad group of stakeholders has met as part of CIVHC’s Delivery System Redesign and Payment Reform Advisory Groups.  Both groups have concluded that Colorado cannot move forward without simultaneously transforming payment systems and the delivery of care.

Given the complexity and controversial nature of such changes, CIVHC hosted a joint strategy session of these two advisory groups in early January.  CIVHC’s Board of Directors and over 25 other stakeholders from around the state were also invited.  The purpose of the session was to develop specific consensus recommendations for Colorado moving forward on payment reform and delivery system redesign over the next five years. With financial support from AcademyHealth, CIVHC invited Harold Miller, a nationally recognized expert in health care reform, to facilitate the session.  Miller has facilitated similar statewide planning sessions for Washington, Wisconsin, Oregon, Nevada, Maine, Tennessee and Ohio. 

Dr. Jay Want, CIVHC’s board president, set the tone for the day by stating, “We have reached a point where we are questioning the federal government’s role in health care and where we cannot produce enough wealth to pay for our health system.”  Considering the current climate of health care reform and the wrangling over legislation at a federal level, Dr. Want expressed his belief that “as communities and as states, we can advance reform models faster and better than the fifty states as a whole.”

The participants were divided into groups focusing on three areas of patient care: preventive care, acute care or chronic care.  Each group’s task was to develop specific recommendations on the ultimate payment methodologies, delivery systems, transitional strategies, pricing mechanisms and barriers to change for patients within each category. The groups were given a list of issues and approaches prepared by Miller for which they were required to develop recommendations through consensus.  Over the course of four hours, the groups wrestled with questions such as:

  • How should primary care practices be paid for patients with chronic disease?
  • What special efforts should be made to help small, rural, and inner-city physician practices transition to new payment models?
  • Should hospitals and providers be paid jointly for major acute care (e.g. surgery, labor and delivery, or other major procedures)?
  • How should specialists be paid for providing preventive care services to patients?
  • How should health improvement services for patients (e.g. weight loss, smoking cessation, etc.) be paid for?
  • What methods should be used to transition to the desired payment systems and benefit designs over the next five years?

After the three groups reached consensus on recommendations for each of the questions posed, they were reconvened into the larger group to discuss conclusions.  Upon each group’s report, the larger group voted electronically on whether they agreed with the recommendations presented.  Despite the diversity of stakeholders, there was remarkable consensus on each working group’s recommendations. A full report of all the issues addressed by the working groups, their recommendations, and voting results will be publicly available in February on CIVHC’s website.

The day concluded with a discussion about next steps.  To achieve consensus among sixty state leaders on health care reform is impressive, but not sufficient.  In the next year CIVHC will plan a statewide learning tour in which we can share our recommendations with Coloradans, learn how these recommendations would impact communities, and build support for CIVHC’s efforts.

Parallel to these efforts, CIVHC will be working ambitiously over the next several months to flesh out multiple details of the recommendations that were developed.  We will also be engaging stakeholders and experts throughout the state to help us create and implement work plans to carry out those recommendations.  If you would like to participate in these efforts, please contact us at for more information.

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