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Power dynamics are important in all types of business. In health care, the power dynamic between health plans (payers) and health care providers has historically been described as imbalanced, which has created tension and frustration. Yet some providers are evening out the playing field with payers using practice data to show how their care teams are improving patient health while avoiding or reducing unnecessary costs.
The shift from a traditional health care environment in which providers are paid for services delivered (volume) to one that rewards value or better health outcomes, has exacerbated historical tensions because success with new payment models requires providers to retool approaches to patient care, invest in new or expand care teams and ensure that data proves their unique value. That takes time and money. There is also confusion over how payers define quality and value and which payment models will sustain the delivery of integrated or whole-person care.
“We keep hearing that health plans want more value and want providers to take on more risks,” said a health care provider, who participated on a panel during the September Multi-Stakeholder Symposium (MSS). “We are trying to work together on how we define value and quality so that we can come up with a common definition for that.”
The key word in that sentence is together.
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Proving your unique value is a key component to success in alternative payment models (APMs) that reward the value of health care delivered. It sounds like a simple equation but there is nothing simple about helping providers prove that what they are doing in practice helps improve patient outcomes and reduce or avoid unnecessary costs—two keys to success in APMs.
Yet data shows that practices engaged in the Colorado State Innovation Model (SIM), a federally funded, governor’s office initiative, are poised for better success in APMs because of practice transformation work funded by SIM. The initiative includes hundreds of practice sites, four community mental health centers and investments in local public health agencies that cover 31 counties and a new workforce to improve connections between providers and community resources.
We can do more to identify, intervene and improve mental health among boys and men in Colorado, and a new report published by the Colorado State Innovation Model (SIM) outlines action steps to do just that. Recommendations are actionable for community members, employers, coaches, health plans and health care professionals and considering that one in five people in Colorado need mental health services, we all have a role to play.
Strategies in “Raising the bar on behavioral health awareness, prevention and treatment for boys and men: A call to action” focus on recommendations for boys and men and will redefine how Coloradans talk about mental health, screen for conditions, enable appropriate interventions and expand access to the right care at the right time in the right place. It goes beyond traditional health care settings and identifies people, who can make Colorado healthier.
I recently described the Colorado State Innovation Model (SIM) as a hybrid approach to healthcare reform that blends practice management and public health because it includes clinical redesign, the business aspects of healthcare and it stretches beyond the traditional walls of clinics to include communities of care.
There are signs that the initiative, which runs through July 2019, and takes a multi-faceted approach to healthcare reform has been successful. Data shows improvement in some patient outcomes yet it’s the stories from patients, who say they feel cared for and safe in SIM practices that represents true success.
‘Building capacity’ is a common phrase among practice representatives who participate in the Colorado State Innovation Model (SIM) to assess processes, revise care teams and refine how data is collected, reported and used to enhance patient care and to negotiate value-based contracts. It’s easy to assume that most of this work is invisible to patients yet during a recent SIM podcast one care team learned otherwise from a patient, whose story prompted an emotional response.
“Hearing that has made all of our hard work worth it just in that one story,” said Kris Hubbell, BS, RN, CHC, clinical quality coordinator, Roaring Fork Family Practice in Carbondale.
Reuniting the head and body in healthcare or integrating behavioral and physical health is one of the primary goals for practices in the Colorado State Innovation Model (SIM). By assessing physical and behavioral health (mental health, substance use and healthy behaviors), providers are poised to improve patient outcomes and avoid unnecessary healthcare costs. And that positions them for success with alternative payment models (APMs).
SIM, a governor’s office initiative that is funded by the Centers for Medicare & Medicaid Services, is supporting 1,847 providers in cohorts 1 and 2, who deliver whole-person care during approximately 3,342,018 annual patient visits. Is your provider one of them? Check our lists.
“It is energizing to give the kind of care you envision instead of being frustrated every day,” said Gary Knaus, MD, Roaring Fork Family Practice, a SIM cohort-1 practice.
This approach, called “whole-person care,” rights a significant wrong in healthcare, said Ben Miller, PsyD, chief policy officer for Well-Being Trust, who explains why he believes integration is the future of healthcare delivery during a SIM podcast.