DENVER — Monday, Feb. 29 — The Colorado State Innovation Model (SIM Office) announced today that seven of Colorado’s health insurers will coordinate with the SIM Office to support efforts that transform the way primary care and behavioral health care are delivered and financially supported in Colorado.
Anthem Blue Cross Blue Shield, Cigna, Colorado Choice Health Plans, Kaiser Permanente, Rocky Mountain Health Plans, UnitedHealthcare and Colorado’s Medicaid program will each provide its own “value-based” payment system and clinical model as part of the Colorado SIM initiative. The initiative will integrate behavioral and physical health care in order to provide better care for Coloradans while decreasing costs. Changing the payment model from one based on fee-for-service is designed to ensure that the newly integrated system is sustainable for care providers, health plans and patients.
“This is the kind of innovation and collaboration that makes Colorado unique, and puts us another step closer to becoming the healthiest state in the nation,” said Gov. John Hickenlooper.
The SIM initiative is funded by a $65 million federal award received by Colorado in December 2014 as part of a competitive process.
The seven health plans signed a Memorandum of Understanding (MOU) committing to good-faith efforts to achieve the SIM vision of whole-person care. They have agreed to:
- Provide value-based payments to primary care practices within their networks. The SIM-chosen practices will be paid based on their progress in reaching specific transformation goals.
- Share necessary and reasonable data with the primary care practices regarding the total cost of care and utilization services by their beneficiaries and members.
- Report progress with a core set of well-established quality measures related to population health that fit into each health plan’s value-based payment and clinical models/efforts with practices included in the SIM Initiative.
- Measure progress with a set of agreed-upon milestones. The health plans will provide appropriate and reasonable data that show how patients benefit by each health plan’s value-based payment model.
- Communicate and meet regularly to ensure that the payment and clinical efforts are supporting the primary care transformation as intended by the SIM Initiative.
“The work of SIM is an integral part of accomplishing our goal to make mental health care or addiction treatment as accessible as primary care,” said Hickenlooper.
“Provider collaboration is one of Anthem’s key strategies to ensure access to high-quality, affordable health care,” said Mike Ramseier, president of Anthem Blue Cross and Blue Shield in Colorado. “True collaborations like Colorado’s SIM project require innovative thinking and trust between payers and providers to work toward common goals, not just a change in contracting, and we thank Governor Hickenlooper and the SIM Office for their leadership in expanding integrated care across the state.”
“We look forward to being part of this effort to transform Colorado’s health care system and make it better for all stakeholders,” said Kim Bimestefer, president of Cigna Mountain States. “The SIM initiative is consistent with Cigna's many collaborative and value-based arrangements with physicians here in Colorado and nationally. It is also consistent with Cigna's fundamental belief that physical and behavioral health care are equally important and should be integrated so that individuals have an opportunity to pursue a healthy, rewarding and fulfilling life.”
“Colorado Choice is excited to be part of the SIM initiative and support practices in the much needed integration of primary care and behavioral health,” said Cynthia Palmer, CEO of Colorado Choice Health Plans. “We are especially excited to work with rural communities. Rural communities often get overlooked when it comes to innovative models that require commitment on new reimbursement methodologies for sustainability.”
“Colorado is the only SIM state with this high level of multi-payer support,” said Dr. Judy Zerzan, Chief Medical Officer, Colorado Department of Health Care Policy and Financing. “Commitments from these payers position Colorado to move toward achieving the triple aim of lower costs, improved population health and better patient experience.”
“As a transformative, statewide effort to bring integrated care to more Coloradans, the State Innovation Model has an impressive scope and reach that calls for collaboration between leaders in health care,” said Nancy L. Wollen, interim president, Kaiser Permanente Colorado. “Kaiser Permanente was founded on the principles of integrated care, so we’re pleased to work with the state of Colorado and health plans across the state on this important initiative.”
“Comprehensive primary care is the foundation of any viable plan to create a health system that works better for people and can only be achieved through the aligned effort contemplated in this agreement,” said Steve ErkenBrack, president & CEO of Rocky Mountain Health Plans. “We believe this joint effort complements the four Accountable Care Organizations UnitedHealthcare launched in Colorado to help the state transition to a health care model that emphasizes value over volume, dedicates more resources to care coordination, and makes it easier to share health information among care providers involved in a patient’s care,” said Beth Soberg, president and CEO of UnitedHealthcare in Colorado.