Whole-person health: A SIM blog (07/31/2018)

Bragging rights: How integrated care improves practice success with APMs
By Heather Grimshaw


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.

The initiative has expanded access to whole-person care, which is increasingly recognized by patients, who appreciate a team-based approach that includes mental and physical health as well as substance use and healthy behaviors.

Colorado was the only state out of 11 selected by the Centers for Medicare and Medicaid Services to pick integrated behavioral and physical health care in primary care settings supported by public and private payers to help providers succeed in APMs. While ambitious, Colorado leaders recognized that long-term success with APMs would require proof that care teams deliver better value at lower costs.

And that requires data that can be shared with health plans (payers). It sounds relatively simple, but it isn’t. It’s expensive to buy electronic health record software that enables providers to collect and report data, and practices must develop processes that are followed by all staff members to ensure consistent, accurate and actionable data.

SIM-funded practice facilitators and clinical health information technology advisors help with this by meeting with quality improvement teams monthly to review processes, assess data quality and assist with reporting requirements.

Proof it’s working: In 2017, 58% of SIM practices can capture and trust clinical quality measures they report compared with 30% in 2016.

And practice data shows that SIM providers are screening more patients for behavioral health issues including diabetes, development delays, obesity and depression to identify issues and intervene to improve health and reduce or avoid unnecessary costs.

National statistics show that untreated behavioral health issues can increase costs. One example: Mental illness and substance use disorders cost employers an estimated $80 to $100 billion annually in indirect costs1.  The team is working with self-insured employers to raise awareness of providers, who offer integrated or whole-person care and included this data in the presentation to the Colorado Business Group on Health: SIM cohorts 1 and 2 practices documented screening 56% of adults and 53% of adolescents for depression. In comparison, a 2017 study shows that 4.2% of adults were screened for depression in primary care settings nationally.

Screening more patients improves the odds of appropriate intervention, and offering integrated, team-based care has improved provider morale, expanded patient access (by enabling all team members to work up to licensure) and reduce or avoid unnecessary costs.

The SIM team continues to see (and publish) the benefits of integrating care and investing in practice transformation work that empowers practice teams to use data wisely and tout their successes.

Not all primary care practice sites offer whole-person care, not all practices screen patients for behavioral health issues that can lead to and exacerbate chronic health conditions. Not all practices invest the time and effort to ensure that care teams are aligned to provide the best possible care, which can be proven with data.

SIM practices volunteered to participate in this federal initiative and are earning their bragging rights to be described as health care innovators.

  1. Finch, R. A. & Phillips, K. (2005). An employer’s guide to behavioral health services. Washington, DC: National Business Group on Health/Center for Prevention and Health Services. www.businessgrouphealth.org/publications/index.cfm