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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.
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It’s easy to get mired in assumptions, stereotypes and misunderstandings when you work in health care. Extricating yourself from that mindset can be difficult yet essential to true health care reform that allows care teams to deliver integrated behavioral and physical health and communicate with data that encourage health plans to sustain it.
That requires true partnerships between representatives from health plans (payers) and health clinics (providers) built on honest and open communication between people, who have had tense relationships that center on cost and payment.
That is slowly changing with Multi-Stakeholder Symposiums (MSS) hosted by the Colorado State Innovation Model (SIM).
Practice transformation requires staff time, resources and a commitment to redesigning processes to ensure the delivery of patient-centered, team-based, integrated healthcare. The Colorado State Innovation Model (SIM) team appreciates the work you do and continues to seek ways to highlight SIM practices with state executives, health plans and patients. As we approach the two-year mark for cohort-1 practices that end their formal participation in SIM March 31, the team continues to gather and share stories of success.
“It’s been very valuable,” Cindy Mattingly, RN, BSN, manager of practice transformation for Rocky Mountain Health Plans, said about SIM practice implementation during the Jan. 18 Multi-Stakeholder Symposium (MSS). “It’s really exciting to see how all of this has grown and the value that you get by participating,” she added.
Mattingly joined representatives from SIM cohorts 1 and 2 practices, health plans that support SIM and practice transformation organizations (PTOs) at the MSS, which is designed to foster respectful discussion about practice transformation work and alternative payment models (APMs) that support it. This was the first MSS for cohort-2 practices and highlighted the need for more frequent discussions between practices and payers about how practices are evaluated, what payment support looks like and ways to develop closer partnerships.
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The second Colorado State Innovation Model (SIM) Multi-Stakeholder Symposium (MSS) May 18 drew about 50 representatives from SIM providers, health plans and practice transformation organizations, who discussed ways to build more effective partnerships. The twist: Attendees assumed different roles — payers played providers (and vice versa) during scenarios—to help them gain perspectives on the unique challenges their colleagues face.
“This exercise made me appreciate initiatives like SIM that give us the opportunity to be at the same table and get on the same page of what’s going on in each individual realm,” said a cohort-1 practice representative. “At the core of good healthcare is relationships.”