Get support for providing whole-person care

Monday, March 20, 2017 12:34 PM

Physician practices improve lives, reduce health care costs

by Heather Grimshaw, Communications Manager, Colorado State Innovation Model

Approximately 900 health care providers participating in the first cohort of practice sites for the Colorado State Innovation Model (SIM) are delivering care with a whole-person approach that addresses the head and body. The SIM office released its application for the second cohort in February and hopes to recruit an additional 150 practices before the application closes March 31.

Whole-person care has been shown to improve outcomes, reduce costs and enhance provider morale.

“There are significant results associated with integrating behavioral health and primary care, including decreases in patient depression and stress levels, enhanced quality of life and lower rates of hospitalization,” said SIM Director Barbara Martin, NP, RN, MSN, ACNP-BC, MPH.

One-year anniversary
February marked the one-year anniversary for 92 primary care practice sites and four bidirectional behavioral health homes that were accepted into the first practice group, or cohort, for SIM, a federal initiative that helps health care providers integrate care and test value-based reimbursement models.

“A focus on both behavioral and physical health are important to the health of patients and the ability of providers to succeed in a changing health care landscape,” said Gov. John Hickenlooper. “The SIM initiative is helping patients lead more productive lives, and guiding practices through new models.”

From a practical standpoint, SIM helps providers progress along an integrated care path continuum that might start with referrals to behavioral health or primary care and could lead to the co-location of professionals.

“In many ways this is pioneering work,” said Lt. Gov. Donna Lynne, who was involved with care integration efforts at Kaiser Foundation Health Plan. She said she recognizes the value of helping patients access the care they need where and when they need it. “We have the willpower and willingness to be innovative in Colorado and appreciate the fact that SIM providers are leaders in this space.”

Continuous improvement
Colorado was one of 11 states selected for SIM model test awards funded by the Centers for Medicare and Medicaid Services, and it was the only state to focus on integrated care with public and private payers as its primary goal. The state will receive $65 million from the Center for Medicare and Medicaid Innovation to implement and test its proposed model for health care innovation. SIM is expected to save or avoid $126.6 million in health care costs with a 1.95 percent return on investment during its four-year time frame, according to a financial analysis. For the year after the test period, the initiative is projected to save $85 million annually, a portion of which will be used to sustain the program.

The right type of care
Delivering integrated care necessitates process and staff changes, which is why SIM provides practice facilitators and clinical health information technology advisors who visit monthly and provide guidance and support. SIM also created a new workforce in the form of regional health connectors who connect practices with community resources, and partners with local public health agencies to reduce stigma and help connect patients to the care they need.

“We think it’s the best way to deliver good care,” said Brian Gablehouse, MD, of Peak Pediatrics in Boulder, one of 100 practices accepted into the first cohort.

Kate Drackett, LCSW, case manager at Juniper Family Medicine in Grand Junction, agrees. “We wanted to offer behavioral health support at the time of a doctor’s appointment, not as a separate, co-located service. Because of SIM we were able to offer that service. … I can be there in the moment for our patients when they need us.”

Capitalizing on full health potential
SIM will help 400 practice sites and four bidirectional health homes engage in this work during its four-year time frame, which ends in 2019. The application period for the second cohort opened Feb. 15. The application process is facilitated by the University of Denver Department of Family Medicine, a SIM partner.

The SIM team received 180 applications for the first cohort and hopes for strong interest from the provider community with one year of practice transformation work underway.
“We have learned a great deal about what it takes to offer integrated care during the first year of SIM implementation, and have modified the program to ensure sustainability,” Martin said. “This type of practice transformation requires a lot of work; yet providers realize that without addressing the behavioral health needs of our patients, we’re really not addressing their full health potential.”

SIM practices receive the following support:

• Achievement-based payments of up to $13,000 for meeting key activities and milestones.
• Small grants of up to $40,000 that help practices operationalize integration efforts.
• Practice facilitators who visit the practice each month.
• Clinical health information technology advisors who visit the practice each month.
• Regional health connectors who identify and help practices tap into community resources.
• Local public health agencies that address stigma associated with behavioral health issues and help create community resources.
• Broadband access to expand telehealth and enhance health information technology infrastructure.
• Business support that help sustain integration efforts.

Additional resources

• Integrated care path continuum: www.colorado.gov/healthinnovation/levels-integrated-care
• Practice transformation article series: www.colorado.gov/healthinnovation/sim-pt-series-2
• Cohort 2 page on SIM website: www.colorado.gov/healthinnovation/cohort2