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Colorado pilot tests payment model to make behavioral health-primary care integration financially viable

Grand Junction, Colo., gets a lot of credit and attention as being home to pioneers in providing high-quality, low-cost healthcare. Healthcare leaders in the city of more than 58,000 are once again demonstrating their initiative.

The Colorado Beacon Community, Rocky Mountain Health Plans, the Colorado Health Foundation, the University of Colorado Denver and the New York-based Collaborative Family Healthcare Association are partnering to test a global payment model that will make the integration of behavioral health and primary care financially viable.

The integration of primary care and behavioral health is nothing new, noted Benjamin Miller, PsyD, board president of CFHA and an assistant professor and the director of the Office of Integrated Healthcare Research and Policy at the University of Colorado Denver. However, organizations that integrate the two care models often find themselves unable to sustain themselves financially over time.

“Part of the reason we have that problem,” Miller said, “is that you have two pots of money to take care of healthcare. You’ve got a mental health pot of money and you’ve got a physical health pot of money. When you talk about integration you have to integrate at multiple levels to make it successful. One of those levels is financial.”

To address the financial conundrum that has bedeviled so many organizations, the partners are launching a three-year, multi-site pilot. They will select up to six practices from Grand Junction and the surrounding area that have already integrated primary care and behavioral health, said Patrick Gordon, Colorado Beacon Consortium’s program director and director of government programs at Rocky Mountain Health Plans.

In the “actuarial exercise” of the pilot, Gordon said that Rocky Mountain will use a model that revalues the impact of intervention on trends at the micro-level. The model will calculate a projected impact on the total spend then will make conservative bets about what the value of the interventions are going to be. Everyone involved in the pilot will try to hit targets that are transparent to all participants.

“… (E)ssentially what we’re doing is accountable care with multiple parties and a community governance structure,” Gordon said. “The difference is that most people talk about accountable care, they say A-C-O – accountable care organization. … For us to be successful we got to drop the ‘O’ off the end of that because when you limit to one organization, even if you achieve a great deal of integration, it’s still limited in space and time. We don’t all report to one CEO. We are all literally trying to collaborate out of a sort of rational self-interest. That is not easy to do but that is what makes this sort of thing possible. It’s not the sort of thing a health plan, regardless of their size, or a hospital, regardless of its power, can really do on its own.”

Building on Grand Junction’s established reputation as a place where innovative collaboration has bent the cost curve and transformed healthcare, Gordon and Miller say the primary care-behavioral health pilot is much more than just trying to solve a financial problem. Their ultimate goal is to create a solution that is replicable across the country and that will change the “rules” of healthcare.

[See also: Seven elements of low cost healthcare; T.R. Reid talks about the good news in healthcare.]

“We are literally in this to change the game,” Miller said, who is the project’s principal investigator. “This literally goes to the heart of healthcare. We believe that by doing this – by integrating care and by figuring out the financial barriers to integrating care – we cannot only help achieve the ‘Triple Aim’ but we can also change the way that our community is actually expecting care and that’s something totally different.”

“This (conversation) is sort of like about payment and national modeling … but the real issue is transformation,” Gordon said. Transformation within clinical practices and disciplines, of relationships between stakeholders and of how patients expect the care they receive and pay for.

“I think that the real battle is not coming up with a magic financing method, because, quite frankly, that’s not that complicated a thing to do,” Gordon said. “The real issue is changing expectations and engaging in a cultural, sort of, transformation around these issues. That’s what will really dictate how fast we’re able to go.”

 

 

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