Whole-person health: A SIM blog (1/10/2018)

Why ‘whole-person health’ matters to providers, patients and payers in Colorado
Setting the stage for the Colorado State Innovation Model

By Heather Grimshaw, SIM communications manager

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.

Many healthcare providers agree that integrated care is the right way to care for patients yet it requires a significant investment of time, energy and staff. SIM practices follow a path to integrate care that includes six levels and 42% of cohort-1 practices moved up a level after a year in the initiative.

Guidance practices receive from SIM coaches (facilitators and clinical health information technology advisors) helps them assess processes and use data effectively to articulate a unique value with health plans during APM contract negotiations.

SIM helps providers transition from fee-for-service reimbursement models to APMs that reward providers for the value (versus volume) of services provided. And integrated care is key to that equation.

"In Colorado, we realized that we couldn't increase quality without incorporating behavioral health in primary care," says Barbara Martin, RN, MSN, ACNP-BC, MPH, SIM director.

In fact, Colorado was the only SIM state to choose integrated care supported by commercial and public payers to help providers succeed in APMs.

Long-term success requires a commitment and investment from healthcare teams, health plans, experts in population health and health information technology, patients and industry members, who participate in SIM workgroups. These stakeholders continue to influence the SIM team’s approach to sustainable healthcare reform.

"The idea behind SIM was that we would create these cohorts [of people and practices] that would learn how to do this, prove it works and demonstrate its effectiveness and efficiency," said Governor John Hickenlooper during a SIM practice visit in Colorado Springs. "Our SIM initiative enables providers to move beyond the theory of healthcare reform and implement meaningful change that improves patients’ lives and avoids unnecessary costs.”

That idea has come to fruition. Work to integrate care and redesign processes started in 100 SIM practices and four community mental health centers in February 2016. A second practice cohort joined in February 2017 and the application for the third and final cohort closes Jan. 19. Encourage practices to apply: https://www.colorado.gov/healthinnovation/apply-cohort-3-last-chance-participate-sim and stay tuned for more detail on what integrating care looks like in SIM practices. The next blog will feature a patient’s story.