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Lessons learned from Colorado's multipayer care integration initiative

Rocky Mountain Health Plans exec shares how insurers drove innovation in behavioral healthcare

Leaders involved in Colorado's multipayer effort to integrate behavioral healthcare offered insights about the challenges and promise of their initiative during an event Thursday hosted by the Collaborative Health Network.

Insurers in the state have been involved in an effort to bridge the gap between behavioral health and medical care by using the Centers for Medicare & Medicaid Services' Comprehensive Primary Care Initiative as a model, FierceHealthPayer previously reported. To accomplish this, they offer incentivized payments to providers to improve care coordination as well as help doctors connect with behavioral specialists.

The approach was particularly effective because primary care offers a "very, very powerful" opportunity to drive change despite it being just a small part of an organization's overall budget, Patrick Gordon, the associate vice president of Rocky Mountain Health Plans, said during the event.

There's a strong business case for such an effort, he said, as Colorado's payers have been able to recognize that when they collaborate to improve care, "we can produce something of value to our own organizations."

He also advocated a less-is-more approach when it comes to outcomes measures, which have taken on increased prominence in an increasingly quality-driven industry.

"I can't tell you have many hours and weeks and months I've whiled away debating which measures to put on a list," he said. "It's irrelevant if you don't have an understanding of how data is used to drive improvement, why feedback matters."

It's not easy, though, to make an investment in change without any guarantee of the outcome, Gordon acknowledged--a sentiment echoed by Vatsala Pathy, director of the State Innovation Model in Colorado. The health policy community is traditionally very risk-averse, she said, but if the industry leaders don't learn to fail gracefully, and improve from it, innovation in the sector won't succeed.

What's more, "if we don't start changing the culture of the organizations we work in, we can't expect providers and practices to do that, as well," Pathy added.

So far, Gordon said, participants in Colorado's initiative have been able to gather examples of the cultural transformation occurring as a result. For example, his organization has heard from frontline clinicians who said being able to work in this environment is "incredibly liberating" because they are able to do what's necessary for quality care without worrying about what to report or how to get paid.

The focus now, Gordon said, is on scaling up efforts like the one going on in Colorado, and that's where policy avenues such as the State Innovation Model come in. Scale is fundamentally a multipayer process, he said, though "it's not about a grant or a new program dialed in from CMS or from Washington--really it's about creating a program to sustain what's already been generated."

To learn more:
- watch the event webcast

Related Articles:
Cigna, Colorado insurers team up to enhance behavioral healthcare
Competing insurers collaborate on data-sharing project
CMS reward plan for coordinated primary care met with praise
States awarded nearly $300 million to create, test care innovation plans