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Have You SIM’d Yet?

For the first time since the Blue Ribbon Commission for Health Care Reform (the 208 Commission) developed its recommendations for comprehensive health reform in 2007-08, Colorado is thinking big about how to transform our health care delivery and payment system. And now is the time for key informants like the readers of this column to weigh in.

The State Innovation Model (SIM) challenge is one of the many opportunities from the Center for Medicare and Medicaid Innovation (the Innovation Center), which was created through the Affordable Care Act. In summer 2012, the Innovation Center asked states to submit plans for comprehensive health care delivery and payment improvements, with the promise of significant funding for those that showed the greatest ability to implement their vision. The Innovation Center didn’t make it easy, though: states were given only about six weeks to develop their plans and funding requests.

Not surprisingly, that timeframe favored states that had already devoted many years to developing such comprehensive plans. And those are the states—Arkansas, Maine, Massachusetts, Minnesota, Oregon, Vermont—that learned earlier this year that they had received multi-year implementation funding from the Innovation Center.

Colorado, on the other hand, had not engaged in broad visioning exercises, with commitment and imprimatur from top public officials, since the 208 Commission. That’s not to say that, as a state, we wasted our time over these last five years. Elected officials enacted many of the Commission’s recommendations: expanding Medicaid and CHP+ (even before the Affordable Care Act expansions), creating a state-run health insurance exchange, establishing CIVHC and the Colorado All Payer Claims Database. CIVHC has convened diverse stakeholders over the last five years to develop consensus visions of payment and delivery redesign. And communities across the state have come together to develop region-specific approaches to improving access and coordination of care.

The SIM opportunity provided the impetus to look at what we’ve accomplished since the 208 Commission and identify where we now need to focus attention in order to control costs and improve the health of our population and the care we provide our citizens. So, under the leadership of Governor Hickenlooper and the Department of Health Care Policy and Financing (HCPF), numerous stakeholders came together in August 2012 to craft the initial State Health Innovation Plan.

When Colorado learned last spring that we had been awarded a small “pre-testing” grant to flesh out those ideas—rather than tens of millions of dollars to implement them—I for one was thrilled. Frankly, if Colorado had received a large implementation grant, we would not have been ready. We needed more time to hear from stakeholders and refine the thinking.

And that’s precisely what has been happening since May. Led by HCPF, numerous groups have convened to identify goals and targets for system transformation, clarify key components, explore how to align Medicaid and commercial health plans around our vision, and consider the impact of our proposed changes on patients.

What has emerged?

A State Health Innovation Plan that seeks to transform our current, fragmented approach to health care into coordinated systems of care that are enabled by accountable, outcomes-based payments rather than the pay-for-volume fee-for-service payment that currently predominates in Colorado.

These systems of care will be built on a foundation of comprehensive primary care. And the journey toward more “system-ness” will begin with one critically important step: integrating behavioral health into primary care. Data demonstrate unequivocally that doing so improves outcomes for patients and significantly reduces health care costs, especially for individuals with chronic conditions (e.g., diabetes, heart disease, asthma) who tend to also have co-occurring mental health or substance use issues.

That is the heart of Colorado’s Innovation Plan. The document lays out specifics for what this integrated primary/behavioral health delivery model can look like, and how to transform primary care practice to provide it. Crucially, there is also a “glide path” for transforming reimbursement—from both Medicaid and commercial health plans—to enable integrated care, and help practices adapt to these new payment models. That payment transformation also applies to the long-term movement toward accountable, coordinated systems of care.

Further, the plan explores the workforce considerations for providing integrated primary/behavioral health, and the health information technology/exchange needed to enable it. It also looks at how to connect public health and clinical care delivery systems to facilitate coordinated systems of care and advance population health goals. And, the plan reflects input from patients and advocates about ensuring that these new health care delivery and payment systems fulfill their promise of improving the patient experience.

Colorado’s Innovation Plan is due to the Innovation Center by the end of November. And it’s not too late for you to weigh in. Go to http://coloradosim.org to review the draft plan and share your comments by November 15.

The Innovation Center expects to announce another implementation funding opportunity early next year. At that time, Colorado will use our Innovation Plan as the basis for a grant request, in hopes of receiving multi-year implementation funding.

It’s important to remember, though, that even if we do not receive federal funding, we have—once again—laid out a consensus roadmap for transforming Colorado’s health care system. The 208 Commission focused on coverage; the SIM process has focused on delivery and payment. The vision of Colorado’s State Health Innovation Plan will guide our state-sponsored programs, commercial health care systems and communities for years to come.

Go to http://coloradosim.org to download the draft of Colorado’s State Health Innovation Plan and share your comments.

About the Author: Edie Sonn is CIVHC's Vice President of Strategic Initiatives. Contact her at esonn@civhc.org.
 

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