Testing new models of care

Thursday, September 01, 2016 12:26 PM

Colorado State Innovation Model offers practice transformation support

by Barbara Martin, RN, MSN, ACNP-BC, MPH, Interim SIM Office Director

While an increasing number of health care professionals are talking about value-based reimbursement, about 100 practices participating in the Colorado State Innovation Model (SIM), an initiative funded by the Centers for Medicare & Medicaid Services (CMS), are taking steps to improve the quality of care and patient outcomes by integrating behavioral health and primary care with help from practice transformation coaches, small grants and other SIM-related support.

The first group of SIM practices started their work in February and the SIM application (www.practiceinnovationco.org/sim) for the second group of practices will be released this fall. The foundational work these SIM practices are completing has been described as a culture change that will be required to succeed in the new payment models that were introduced by the Medicare Access and CHIP Reauthorization Act, says Emilie Buscaj, MPH, PCMH, CCE, program manager, HealthTeamWorks.

“Practices see a need to prepare for payment reform, yet it’s difficult to justify the time necessary to address how this change will affect practice culture,” explains Buscaj, who manages practice facilitators, a coaching service that is included in the SIM transformation package of support. Practice facilitators meet with SIM practices twice a month to review progress toward SIM milestones and update practice improvement plans that help the practice move from volume- to value-based health care delivery. “Practice professionals are busy,” Buscaj adds. “Our goal is to prepare practices so they are able to address changes in the environment before it’s too late.”

SIM practices receive the following benefits to help support this transition:

• Facilitation of relationship with payers: Six private payers and Medicaid signed a memorandum of understanding indicating a willingness to make a good faith effort to support SIM-participating practices with value-based payments. The SIM office is working to foster an ongoing dialogue between payers and providers to ensure that reimbursement models support and sustain the transition to new care delivery models.
 
• Small grants: SIM-participating practices have the opportunity to apply for grants (up to $40,000 per practice) that support the integration of behavioral health integration and business practice redesign for new care delivery models.
 
• Participation payments: Each SIM practice is eligible to receive up to $5,000 to help them meet key practice transformation requirements.
• Business consultation support: SIM practices receive various forms of support to help ensure that transformation efforts are financially successful.
• Expert technical assistance: SIM practices are matched with at least one practice transformation organization that provides expert guidance, including the following in-person resources:
  • A practice facilitator to guide the participant’s practice improvement team in ongoing change and quality improvement activities.
  • A clinical health information technology advisor (CHITA) to help build practice data capacity. SIM recognizes that data is only actionable if it is accurate and trusted, which is why CHITAs will work with practices to support their collection and use of accurate, actionable data.
• Opportunities for Continuing Medical Education (CME) credit: Providers have the opportunity to earn CME credits twice yearly during in-person Collaborative Learning Sessions and through online courses.
• Maintenance of Certification (MOC) credit: Eligible providers who participate in the quality improvement process can use this project to satisfy MOC requirements.
• Regional Health Connector (RHC): SIM practices will have access to the RHCs, who are based in local community organizations and are dedicated to connecting practices to relevant community and state resources.

Federal initiatives support innovation in the state
In addition to the SIM, Colorado primary care practices also have an opportunity to participate in the Comprehensive Primary Care Plus (CPC+) initiative from the federal CMS, which dovetails with SIM efforts underway.

Colorado was selected as one of 14 regions for the CPC+ initiative and the application was open from Aug. 1 through Sept. 15. Learn more about SIM, the differences between SIM benefits to support behavioral health integration and the CPC+ initiative by reading a series of frequently-asked questions with answers (www.colorado.gov/healthinnovation/cpc-sim) from SIM subject matter experts. 

Learn more:

• SIM overview: www.colorado.gov/healthinnovation
• SIM frequently-asked-questions: www.colorado.gov/healthinnovation/cpc-sim
• SIM application: www.practiceinnovationco.org/sim