Colorado: New programs for integrated and value-based care


In February 2015, the State of Colorado received a Centers for Medicare and Medicaid Innovation Center (CMMI) State Innovation Model (SIM) grant to implement and test its proposed model for healthcare innovation. Under the SIM grant, Colorado can receive up to $65 million to improve the health of Coloradans by:

  • Providing access to integrated primary care and behavioral health services in coordinated community systems;
  • Applying value-based payment structures;
  • Expanding information technology efforts, including telehealth; and
  • Finalizing a statewide plan to improve population health.

The end goal is that by 2019, at least 80% of Colorado residents will have access to integrated physical and behavioral health care services in coordinated community systems that leverage value-based payment structures. When fully implemented, the plan is projected to generate $126.6 million dollars in total cost of care savings by 2019, with annual savings of $85 million thereafter to help sustain the model. It is a lofty goal, but one that seems attainable if the appropriate actions are taken by those administering the grant.

So what has Colorado done in the last 12 months since receiving this transformational award from CMMI? As it turns out, quite a bit!

Since receiving the award, Colorado has established the Colorado SIM Office, appointed an Advisory Board, convened Stakeholder Workgroups consisting of 134 thought leaders, garnered commitments from public and private payers, conducted a statewide outreach tour, and held more than 70 stakeholder meetings. However, there is a lot of work left to do between now and 2019 to ensure that Colorado residents are getting the type of integrated and value-based care they need. Let’s take a closer look at some of the upcoming activities that are planned and the impact on various stakeholders in the industry.

Payment Reform

Colorado’s plan is to implement a multi-payer program that includes health plans initially aligned under the CMMI Comprehensive Primary Care Initiative, including Aetna, Humana, Cigna, Kaiser Permanente, UnitedHealthcare, Anthem, Colorado Choice, Colorado Medicaid, Rocky Mountain Health Plans and Colorado Access. Participating payers have committed to a shared set of common measures that include 12 population health measures, 18 quality of care measures, and per capita total health care spending measures. For providers in Colorado, this means less administrative burden when it comes to reporting measures, but there still may be challenges related to data aggregation and tracking performance in a way that supports real-time improvement.

Practice Transformation

The first cohort of primary care practices participating in practice transformation efforts was announced in February 2016. These practices have committed to 10 SIM Practice Transformation Milestones and will receive support from the state in the following areas: practice facilitation, clinical health IT advisors, bi-annual learning collaboratives, and access to capital. An additional 150 practices will be onboarded in 2017 and 2018, so provider groups with an interest in joining the initiative should pay close attention to the Colorado SIM website for application information and should begin thinking about the infrastructure needs to support program participation.

Population Health

The Colorado SIM population health strategy leverages the public health system to promote community outreach and education, reduce stigma, develop provider training, and advance locally identified strategies for prevention of behavioral health disorders. In early 2016, the Office of Behavioral Health (OBH), housed within the Colorado Department of Human Services, developed and disseminated an online Substance Use Disorder course to enhance integrated behavioral health. Providers and medical groups in Colorado can find tools and resources related to behavioral health services on the OBH website.

Health IT

Colorado’s SIM health IT strategy focuses on a number of areas, including creating reporting tools that will provide practices and other relevant stakeholders with actionable data and laying the foundation for the integration of clinical and claims data. The SIM HIT strategy also includes development of a common tool, now called the Shared Practice Learning and Improvement Tool (SPLIT), which can be used for SIM and other statewide projects, beginning with the Cohort 1 practices starting in 2016. While the SPLIT tool will benefit medical groups in Colorado participating in statewide reporting efforts, groups of 100+ providers may find that additional technology is needed to manage quality measure tracking and reporting across both public and commercial payer programs.

Information from this post was gathered from the Colorado SIM Operational Plan, revised January 6, 2016.

Further reading:
How using the MIPS 90-day reporting period will increase your 2017 Composite Score
Avoiding a penalty in 2018 MIPS: the nuts and bolts

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