Health care reform

Tuesday, September 01, 2015 12:24 PM
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Changing how care is delivered and paid for – the time is now!

by Perry Dickinson, MD

We have been talking about “health care reform” for years and it seems the time for action on a large scale is finally presenting itself, ripe with opportunity – and Colorado is ready!

It has been a long time coming and many of us have been preparing for this in various capacities for years. Perhaps you remember the CMS Physicians’ Congress for Health Care Reform – the group of committed physician leaders that began meeting on Saturdays starting way back in 2008? You are also probably well aware of some of our pioneers that have been working on medical homes, systems of care, transitions of care, meaningful use and behavioral health integration into primary care, starting way before these terms became part of everyday conversation. Well, now it’s time to go mainstream! It’s time for an “all in” approach to improving the health of Coloradans, balancing a focus of reducing the cost of care, while also improving the experience of care for patients, families and health care teams. Practices that are prepared should do well in the changing system; those that do not pay attention now risk falling by the wayside.

Payers are now ready to take what started out as pilots to scale in a major way. By 2019, the Center for Medicare and Medicaid (CMS) has committed to a goal that 90 percent of Medicare payments will be directly tied to value. The commercial carriers and Colorado Medicaid are on a similar trajectory. However, being paid for value, not activity, means new models of care delivery must be implemented that can demonstrate value – with comprehensive data, including clinical as well as claims data. The new models involve challenging changes in care delivery and the use of data. Practices benefit greatly from support in making these changes, which take time and certainly do not happen overnight.

Two opportunities in particular are available statewide for primary care participation. The Colorado State Innovation Model (SIM) is open to primary care practices, with a focus on assisting practices in moving to advanced primary care that includes behavioral health integration and alternative payment models. Through SIM along with other collaborative projects, the payers are building an aligned framework for a new system of care and payment. While the details of the payment reforms for SIM are not yet fully known, payers have committed to supporting practices in this effort. Please visit to learn more on this exciting opportunity.

The other opportunity is the AHRQ-funded EvidenceNOW Southwest, with a focus on cardiovascular risk mitigation and the new CVD guidelines for managing heart health for adults. EvidenceNOW is also a great initial preparation for practices not quite ready for SIM, but wanting to engage with SIM in 2017 or 2018, or otherwise begin to prepare for the new payment models.

Applications are being accepted now for both programs, and we welcome your interest and participation. For additional SIM information and to access the application please go to For additional information on the EvidenceNOW SW program, please visit

The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

These opportunities and more are offered through the Colorado Health Extension System, a collaborative of more than 20 organizations in Colorado that provide support for practices in various quality improvement and practice transformation projects. CHES provides a mechanism for coordinating practice transformation support across Colorado, aligned with the emerging payment models.

Posted in: Colorado Medicine | Practice Evolution | Practice Redesign | Health System Reform


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