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Aligning Delivery and Payment Reform for Maximum Impact

As one looks at the efforts to transform health care delivery and payment in Colorado, two overwhelming impressions emerge. The first is the sheer quantity of innovation underway in our state. To see what I mean, look at CIVHC’s Inventory of Payment Reform and Delivery Redesign Strategies and the graphic that accompanies it. While we’ve done our best to be comprehensive, we know we’ve left important initiatives off these documents (and please contact us if yours is missing). But even our non-exhaustive list requires nearly two dozen pages to describe.

The second impression is the alignment of these initiatives, and that really stands out on the graphical representation. Look at the number of efforts centering on care transitions, physical/behavioral health integration, medical homes and the like. There is a clear convergence of approaches. And it becomes all the more striking when you consider the overlap among our categories and among many of the projects listed there. Many of the medical home initiatives incorporate care transitions components, as do a number of the physical/behavioral health integration projects; similarly, many of the programs listed under care transitions fold these other coordination strategies into their approaches.

In other words: whatever the label or the primary mechanism, Colorado’s health care delivery system is aligning around greater integration of care.

This convergence is enhanced by the funding coming to Colorado from the Center for Medicare and Medicaid Innovation (CMMI), which is explicitly focused on supporting initiatives that coordinate care and pay for value, not volume. Physician Health Partners’ Pioneer ACO designation reinforces their approach to coordinating care for Medicare patients to hit outcomes targets within global budgets. Five of the seven Innovation Challenge projects in Colorado integrate physical and behavioral health; two are designed to improve transitions of care. And the Comprehensive Primary Care Initiative enhances Colorado’s already robust foundation of medical home care coordination and payment.

And, you can see this alignment in Medicaid efforts aren’t yet captured on our documents. HCPF is working hard to figure out how to integrate its capitated approach to paying for behavioral health with the Accountable Care Collaborative that coordinates care and payment for physical health services. And the state just submitted a State Innovation Model (SIM) Testing application to CMMI to support an ambitious vision for integrating physical and behavioral health services in both Medicaid and commercial insurance.

That last development is an exciting one for thinking about alignment on a larger scale and in a more intentional way. It’s critical that, as we continue to drive toward greater coordination of care, we do so in ways that will enable coordination of a different kind: between commercial health plans and public programs. Our SIM proposal offers a means to do just that – converging the philosophy, delivery and payment of integrated care for Medicaid enrollees with the philosophy, delivery and payment of coordinated care for the commercially insured. Yes, these populations are different, as are the systems that pay for their care. But if we truly want to scale up these many complementary initiatives into a statewide vision for transforming care, we need an aligned approach that works for citizens regardless of their coverage. And we need delivery and evaluation mechanisms that are consistent enough to allow providers to meet quality benchmarks across all their patients, not just a subset.

Colorado’s health care providers and payers are coalescing around shared strategies in an organic fashion. Now it’s time to turn this natural convergence into intentional alignment, for maximum impact.

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

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