Executive office update: Colorado’s collaborative, consensus-based approach

Tuesday, September 01, 2015 12:07 PM

by Alfred Gilchrist, CEO Colorado Medical Society

The 2015 Colorado Health Access Survey, conducted by the nonprofit, non-partisan Colorado Health Institute, announced this month that the state’s uninsured rate has fallen by more than half in the last three years. This is a spectacular manifestation of the methodical adoption and implementation of coverage expansion options afforded by federal law – the Medicaid expansion, a health insurance exchange and a health insurance co-op, along with employer-based coverage underpinned by a political culture that has long been committed to what is now formally adopted as a statewide goal to make Colorado the healthiest state in the nation.

A prestigious national journal will soon publish their findings on what makes us tick, reaffirming our collaborative, consensus-approach: “Much of the Colorado health community embraces the concept of stewardship for the state government: the notion that the state has responsibility for improving the quality and controlling the costs of the health care system. Colorado carries out this role primarily through building consensus, rather than exerting its legal authority.”

According to the new data, less than 7 percent of Coloradans do not have insurance, the envy of most of the country, no doubt, and access has been maintained along with population health – with more serious work to continue in the gaps.

This “fix-problem-not-blame” consensus-building approach allows for innovation and avoids what has plagued many states – the classic zero sum politics of health care policy where one move cancels another and the performance curve remains shallow to flat. We have thus far avoided the heroic autocrat model where an oligarchy of special interests or a powerful political cartel simply mounts up and rides over or blocks competing ideas. Ideas are more sustainable as policy, and easier to adjust over time – since policy perfection is an oxymoron – if the leaders are not focused on winning out over a competitor or getting even.

So the homegrown organics of these organizations are the underlying chemistry that produces sustainable results over the long haul, meaning there are enough mature adults with the right kind of leadership stuff and policy expertise – a been-there-done-that wisdom that comes from experience. If there is an X factor to explain Colorado’s progress, it is culture and leadership.

We could post an honor roll of the qualitative talent and maturity of leaders in any sector – medical, hospital, health plan, and government who persistently and consistently do the work in what can be a frustratingly iterative and methodical process to get to the sweet spots. CIVHC’s recently published inventory of payment reform and delivery system redesign projects reads like a Who’s Who of those who have been there and are doing that. It is the gift that keeps on giving back to their communities. “Stewardship” is how the national publication will describe Colorado later this month. Stewardship is sufficiently embedded as to become a part of the Colorado culture, and thus grows into all corners of care delivery and innovation.

It is the norm, not the exception. A recent and exciting blooming of this X factor falls in the workers’ compensation component of care delivery, where Pinnacol Assurance – the dominant comp carrier – has assembled a dream team of leaders and experts from Colorado’s talent pool of veterans. Former CIVHC CEO, Phil Kalin, heads the new team that includes former CMS President Rick May, MD, as senior medical director; Edie Sonn, an alumna of CMS and the Blue Ribbon Commission on Coverage, as patient advocate and senior vice president of communications and public affairs; and Karyn Gonzales as vice president of medical operations and health care strategy, who brings a stellar background in clinically integrated networks.

Like their counterparts in other sectors, Pinnacol has a strong sense of community and ownership. With the full backing of the Pinnacol board, this dream team will focus on improving health and wellness in the workers’ comp system, including a move to integrate and align efforts between physicians and comp insurers, bridging the gap between workers’ comp and traditional health insurance, and a sharp focus on reducing the hassle factors within the system.