Colorado takes steps toward integrating behavioral health care

By David Brendsel | Prevention Services Division

 

photo of SIM team membersA small group of state employees, working with public and private partners statewide, has hit the ground running on the four-year effort to integrate behavioral and primary care across Colorado. Three months into the project, the State Innovation Model (SIM) Office has:

  • Named a steering committee and set up workgroups to research and help implement project components. The four main components are health information technology, practice transformation, payment reform and consumer-based population health improvements, known collectively as the Colorado Framework.
  • Developed a website to share information and resources.
  • Advanced relationships with health plans, hospitals, health care providers and other partners who will help guide and implement the Colorado Framework.

The Colorado SIM project is led by the Governor’s Office in collaboration with the University of Colorado and state departments of Health Care Policy and Financing, Human Services and Public Health and Environment.  Nine health professionals work in the SIM Office, housed at the Colorado Department of Public Health and Environment’s Glendale campus.

“We understand the connections between mind and body, and integration of behavioral health and with physical health services is a critical need for Colorado and our nation,” said Susan E. Birch, executive director for the Colorado Department of Health Care Policy and Financing. “This grant will allow us to reach approximately 80% of our state’s residents to provide them with the support they need to move toward greater integration.”

Despite proven links between conditions of the mind and body, there is insufficient integration in the care for such conditions. More than two-thirds of those with behavioral health disorders don’t get treatment. Those who do get treated often rely on their primary care physicians, but just as often ignore referrals to behavioral health providers. Many primary care providers aren’t trained on or comfortable with discussions of a patient’s mental or behavioral health problems. The $65 million, federally funded SIM project hopes to change all that by building a state health care system that improves health care delivery, value and outcomes in 400 practices statewide.

“We’ve made a lot of progress, but there’s a long way to go” says SIM Director Vatsala Pathy, “It really has to be a culture change.”

Project implementation begins next year. By December, the Colorado SIM Office plans to select a first-year cohort of 100 health care practices willing to integrate primary and behavioral health care, sign agreements with health plans, contract with vendors and release a request for proposals to distribute the first $750,000 in grants to local communities.

“Communities will be the locus of activity,” says Pathy. “This is not a top-down initiative.”

That’s because there is no one model for the integrated delivery of primary and behavioral health care, she said. In some places, a primary care office may include behavioral health services. In other places, a behavioral health clinic may take the lead in working with primary care physicians. And in between those models, depending on community capacity and need, any number of permutations may emerge to address the healing of both the mind and body.

To manage these different models and achieve project goals, workgroups will focus on engaging consumers, building a health information technology system, developing a value-based payment system, promoting policy reforms, training and supporting practices and providers, identifying and enhancing the future health care workforce and evaluating their efforts.

“If we want to make Colorado the healthiest state in the nation,” said state health department Director Dr. Larry Wolk, “We must treat the mind and body.”