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A Note Taker’s Perspective on Collaboration and the State Innovation Model

When Colorado received a State Innovation Model Pre-Testing Assistance Award from the Centers for Medicare and Medicaid Services (CMS) in March 2013, I had no idea that I was about to witness a study in hard work, collaboration, and progressive thinking. Multiple organizations and state offices have worked on the State Innovation Model (SIM), including the Department of Health Care Policy and Financing, the Colorado Health Institute, University of Colorado’s Department of Family Medicine, and CIVHC.  As part of the goal to make Colorado the healthiest state, the SIM plan focuses on integrating physical and behavioral health. The process involves Colorado stakeholders on multiple levels, from a large stakeholder advisory group, to issue-specific work groups, to a project management team. CIVHC is a member of the management team as well as the staff for the SIM Public Health Work Group. With the help of chair Lisa Van Raemdonck (Executive Director, CALPHO), Edie Sonn (Vice President, CIVHC), and Kristin Paulson (Senior Manager of Policy and Initiatives, CIVHC), a group of individuals from varied backgrounds and viewpoints provided exceptional insight and feedback for the public health section of the SIM plan.

As the group’s note taker, I was able to witness the dynamics of the work group, and to see their questions, suggestions, and knowledge shape a document concerning public health in Colorado. When the group first convened, the differences in opinion and a still developing understanding of the scope and nature of the work group provided a broad and diverse set of feedback for the staff to process.  As the group became more familiar with each other and the goals of the SIM work, their individual experiences and knowledge began to build upon each other. During the final meetings of the group, members were able to locate areas for improvement and emphasis and contributed to a document that not only addresses integration and public health in Colorado currently, but also provides recommendations for a future with better integration of care and higher quality of care. As Edie mentioned multiple times throughout the process, the work of the group was important not only for the SIM plan, but to have as a reference document to change Colorado for the better independently of a specific program.

Through the five meetings of this group, I learned more about the state of public health in my state than I thought possible. I also became aware that when one is in a room full of passionate, intelligent people with their minds set on identifying a solution to a problem, the results can defy expectations. Below are a few key points that I saw come out of the SIM Public Health Work Group.

  1. Communication is key. This may be an obvious point, but the importance of communication was demonstrated on many levels through this work. When we began discussing current and potential barriers to successful integration, communication was a primary concern. Electronic records have a difficult time passing from behavioral health and physical health providers. Information and data is available, but not easily accessible, and some workforce members require additional training. These highlight the importance of effective communication on a systems level. Within the group, the dialogue was dependent on members engaging with each other although they may have differing opinions or areas of expertise. Instead of causing gridlock, the group found strength in diversity and provided well-rounded input. Seeing how Lisa, Edie, and Kristin modeled effective facilitating also underscored the importance of communication in this process.
  2. Colorado is a cradle for innovation. During our third meeting, the group was presented with examples of behavioral and physical health integration within public health. The presentations and demonstrated outcomes of the North Colorado Health Alliance, Pueblo Triple Aim, and Jefferson Center for Mental Health showed that not only is this type of integration desirable in Colorado, it is possible. By taking note of what successful projects in the state have done and including those methods in the report, the group highlighted innovative programs already in place and increased the likelihood of future success. A map of current integrated care programs in Colorado can be found here.
  3. Public health is critical to integrating care. Much of the conversation concerning integration of care focuses on primary care and behavioral health providers. Prior to starting at CIVHC, I was unaware that Colorado’s public health systems provide crucial services and are absolutely vital to the goal of making Colorado the healthiest state. This is especially true for integration of care. The group emphasized the role of public health in assisting and supporting other integrated care programs in addition to helping integrate care in its own right. The importance of public health systems is included in the report, and I also hope that it receives more coverage outside of the SIM work as well.

The work being done on the State Innovation Model is astounding. Although I only directly experienced the work of the public Health Work Group, the ideas and recommendations emerging from this work will hopefully encourage great improvements in the quality of care throughout Colorado.

About the author:  Cortney Green is Program Assistant for CIVHC. Contact her at

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