Health care transformation

Saturday, November 01, 2014 12:26 PM

Colorado’s State Innovation Model driving transformation

by Kate Alfano, CMS contributing writer

The State of Colorado has qualified for second-round funding for the State Innovation Model, or SIM, grant. SIM Phase 2 will facilitate the integration of physical and behavioral health and accelerate public and private sector collaboration on multi-payer models and delivery system transformation. It opens unique opportunities for the Colorado Medical Society to drive innovation and health plan standardization, and CMS is proactively positioned to promote payment and delivery system reform priorities for members and patients.

The State of Colorado has been working on the SIM initiative for two years, explained Katherine Blair, senior policy advisor on health to Gov. John Hickenlooper. The Colorado SIM team first submitted an application to the federal government for funding in September 2012; they received a planning grant in March 2013 to refine the original proposal and submitted this new proposal in July 2014.

SIM will allow the state to “pull the pieces together,” said Judy Zerzan, MD, MPH, chief medical officer and director of client and clinical care at the Colorado Department of Health Care Policy and Financing. This includes federal initiatives like the Affordable Care Act and the Comprehensive Primary Care Initiative; community health needs assessments and public health improvement plans; the governor’s “State of Health” initiative and existing SIM work; HIT infrastructure; and recommendations from the 208 Commission and the new Commission on Affordable Health Care.

“This isn’t one more separate effort,” she said. “Really we see SIM as a process that’s linking the things that are already happening and trying to have a platform so it can all come together and make sense. We see the SIM effort as how we get health care transformation in our state.”

Katherine Blair Mulready, left, senior policy advisor on health to Colorado Gov. John Hickenlooper, and Judy Zerzan, MD, MPH, chief medical officer and director of client and clinical care at HCPF, present the latest on the State Innovation Model.

The goal of the SIM initiative is to improve the health of Coloradans by providing access to integrated primary care and behavioral health services in coordinated community systems, with value-based payment structures, for 80 percent of the state’s residents by 2019. It is widely acknowledged that the current health care system is inefficient and expensive; patients are often treated one condition at a time when evidence shows that caring for the whole person – body and mind – leads to better health.

SIM will “get everyone on the bus,” Zerzan said. “We will form a strong partnership between public health and health care that coordinates clinical, public health, technology and community resources.”

The SIM team has six different roles on which they’re looking to focus work, Zerzan said:

• Patients will have an easier time getting the care they need and will experience seamless care delivery addressing both physical and behavioral health needs.
• Providers will work side-by-side to treat patients’ physical and behavioral health needs with ongoing support from SIM to smooth the transition.
• Policymakers will ensure that rules and laws support the transition and evaluate the reform progress.
• Public health will partner with providers to improve population health.
• Health information technology will help provide interconnected medical records and support telehealth.
• Payers will move toward models based on quality and value of care.

SIM will provide practice transformation services to 400 practices as they integrate behavioral health and primary care starting in 2016. The management team is in the process of determining selection criteria and processes for practices and will consider provider/patient panel size, geographic location, community support, affiliation with payers and health systems, and current integration status.

The implementation plan “stair-steps” in its progression. SIM practices start in the observation phase during which they will identify current spending and future benchmarks for spending, understand needs to transform the practice, and identify outcome and quality baselines. Second is care coordination and savings where practices will demonstrate increased coordination through additional payments, receive support in practice transformation, and measure performance and quality.

The third step is shared risk and savings, during which providers will have more responsibility and accountability with extra payments built into the total cost of care. Practices will continue to receive support in practice transformation and report on performance and quality. Fourth is payment and budgeting for comprehensive primary care; this stage includes a learning collaborative, payment based on total cost of care and coordination, and continued performance, quality and cost measurement.

Zerzan invites CMS members to consider joining one of the SIM workgroups: HIT, Data and Quality Measures; Payers, Purchasers and Payment Reform; Service Delivery and Practice Transformation; Population Health and Consumer Engagement; Workforce; and Evaluation. For more information on the workgroups and to sign up, visit www.ColoradoSIM.org.