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Integrating an Entire StateHow Colorado Ensures Equal Access
from Rural Areas to Urban Centers
Randall ReitzSt Mary’s Family
Medicine Residency
Shi ColemanColorado State
Innovation Model
Stephanie KirchnerUniversity
of Colorado
Mike OlsonSt Mary’s Family
Medicine Residency
Alex SchmidtRocky Mountain
Health Plans
Heather StockerUniversity
of Colorado
Faculty Disclosure
The presenters of this session have NOThad any relevant financial relationships during the past 12 months.
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4. Kessler RC, Demler O, Frank RG, et al. Prevalence and Treatment of Mental Disorders, 1990 to 2003. N Engl J Med. June 16, 2005 2005;352(24):2515-2523.
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6. Rural Health Information Hub. Rural Mental Health. 2017. https://www.ruralhealthinfo.org/topics/mental-health
7. Rural Health Reform Policy Research Center. The 2014 Update of the Urban Rural Chartbook. https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf
8. Rural Health Statistics 2017. www.cdc.gov/ruralhealth. 9 Th S f M l H l h i A i 2017 h // lh l h i
Bibliography / Reference
99 02 05 08 12 15 18
2011 -2015
New sites come online through CPC, ACT, and
SHAPE
2015 - 2017
New sites come online through CO-EARTH,
SIM, and CPC+
2004
RWJ grant ends.
IC Council awarded a 5-year grant to expand model to 3 other safety net clinics and
2 for-profit clinics.
2009
IC Council prepares a community white paper to
celebrate 10 years of success.
Paper signed by all major healthcare partners in the
community.
2006
Pre- post-study of Marillac’sIC services published.
IC Council members make numerous professional
presentations on the “Grand Junction model”.
1999
Larry Mauksch completes a year-long sabbatical at Marillac
Clinic in Grand Junction
2000
Creation of the Integrated Care Council.
IC Council awarded a 4-year RWJ grant to pilot full-integration at Marillac Clinic.
School of MedicineUniversity of Colorado
CO-EARTH Team
RMHP QI expertise
St. Mary’s BH
expertise
CUDFM system
landscape consultation
Partnership with Rocky Mountain Health Plans (RMHP)
• 10 years of experience in practice transformation • Colorado Beacon Project • Advancing Care Together (ACT)• Comprehensive Primary Care initiative (CPCi)• Comprehensive Primary Care Plus (CPC+)• State Innovation Model (SIM)• CO-EARTH
Partnership with Rocky Mountain Health Plans (RMHP)
Community partnerships
Payment reform
System trans-
formation
RMHP’s Role in CO-EARTH and SIM
CO-EARTH SIMQI Advisor/Practice Facilitator X XClinical Health Information Technology Advisor (CHITA)
X
Integrated BH Advisor XPotential payer support for practices XMonthly phone calls XTwice monthly meetings XHost learning collaboratives X X
CO-EARTH Program: Practice Support
• Resource website • Introductory and final site visit
• Shadowing & on-site training• Monthly phone calls
• RMHP Quality Improvement Advisor • St. Mary’s FMR Behavioral Health Faculty (CO-EARTH PI)
• Additional support from QIAs• PDSAs, process mapping• Additional practice transformation programs (TCPi,
CPC+, etc.)
CO-EARTH Learning Collaboratives
• June 2016• Co-facilitated with
SIM Cohort 1
• June 2017• Limited to CO-EARTH
participants
CO-EARTH Learning Collaboratives
• June 2016• Co-facilitated with
SIM Cohort 1 • Leadership to support
culture of IBH• Diverse workflows to
support IBH• BH risk stratification• Emerging roles on
healthcare teams• Pediatric behavioral
health in primary care
• June 2017• Limited to CO-EARTH
participants • Financial
sustainability• Leadership & protocol
development • Roundtables (e.g.
ADHD, marketing, somatization, EHR)
• Chronic pain
CO-EARTH Pre-Assessment
IPAT – Integrated Practice Assessment Test
CSA – Clinic Self-Assessment
Level of Participation
CO-EARTH Program: Curriculum
Coordinated care track
Co-located care track
Integrated care track
WHAT IS COLORADO SIM?
• State Innovation Model-an initiative supported by the Center for Medicare & Medicaid (CMS)
• Colorado was awarded a $2 million planning grant and $65 million implementation grant to strengthen Colorado’s Quadruple AIM strategy
• Started February 2015 and runs through July 2019
• SIM program encourages states to develop and test models for transforming health care payment and delivery systems
• Colorado received the 4th largest award based on the State’s population
STATE INNOVATION MODEL (SIM) BACKGROUND
16
VISION – To create a coordinated, accountable system of care that will provide Coloradans access to integrated primary care and behavioral health in the setting of the patient’s medical home.
GOAL - Improve the health of Coloradans by providing access to integrated physical & behavioral health care services in coordinated systems, supported with value-based payment structures, for 80% of Colorado residents by 2019.
SIM GOALS
THE SIM APPROACH
Public Health
Behavioral Health
Providers
Consumers
Practice TransformationPayment Reform
Population Health
HIT
80% of Coloradans have Access to Integrated Care
Support for practices as they
accept new payment models
and integrate behavioral and physical health
care.
Engaging communities in
prevention, education, and
improving access to integrated care.
Development and implementation of
value-based payment models
that incentive integration and
improve quality of care.
Secure and efficient use of
technology across health and non-health sectors in order to advance integration and
improving health.
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• Integration of physical and behavioral health care in 400 practices over the four year grant period
• Implementation, assessment and technical requirements for practices to move toward integrated care and new payment model implementation
• Creation of Toolkits, Coordination of Collaborative Learning Sessions, Dissemination of Best Practices, Provision of Technical Support, etc.
SIM INITIATIVE TIMELINE
19
Planning & Ramp-up, including identification of assessment tools
Additional 156 practices on-boarded
2015 2016 2017 2018
Initial 100 practices on-boarded/92 maintained Additional 152 practices to
be on-boarded
2019
COHORT 1-2DEMOGRAPHICS
21
REGIONAL DISTRIBUTION ACROSS THE STATE
PRACTICE MILESTONES & CHANGE PACKAGE• Based on Bodenheimer 10 Building Blocks for High-Performing Primary Care
framework • Aligned with payer recommendations in Colorado• Road map to be adapted to each practice according to its resources, setting,
payment structure, etc.• Components reflect Colorado SIM’s target focus on:
• Behavioral Health Integration• Population Health
• Full document found in the ‘Resource Hub’ section of the University of Colorado’s – Practice Innovation Program website http://www.practiceinnovationco.org/sim/simimplementationguide/Bodenheimer, et al. Ann Fam Med March/April 2014 vol. 12 no. 2 166-171 22
23
SIM BUILDING BLOCKS - MILESTONES
24
SIM BUILDING BLOCKS - MILESTONES
25
SIM BUILDING BLOCKS - MILESTONES
• Practice Facilitators
• Clinical Health Information Technology Advisors
• Regional Health Connectors
CARE TEAM FOR PRACTICES
26
Unique approach toward integrating behavioral and physical health
27
More practices implementing integrated models of behavioral health care!
PROVISIONAL DATA FOR THE IPATINTEGRATED PRACTICE ASSESSMENT TOOL
28
Practices are adopting the building blocks of advanced primary care!
PROVISIONAL MILESTONE INVENTORY DATA
29
Progress,but room to improve on screeningrates.
Process improvements need to translate into patient outcomes.
45.82%
34.35%38.81%
49.74%
48.77%
52.20%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
2016 Q1 2016 Q2 2016 Q3 2016 Q4 2017 Q1
Aggregate percentage of eligible patients screened for Depression in SIM Cohort 1 primary care practice sites -from February 2016 through March 2017
Cohort 1
CO SIM Accountabilitytarget
30
With added work of SIM, staff are not burning out more. Burn out rates are remaining fairly stable.
PROVISIONAL CLINICIAN & STAFF BURNOUT DATA
TAKE-AWAYS: Working to Ensure Equal Access Rural and Urban Areas
31
Builds on Meeting Practices Where They Are CO-EARTH SIM
Standardization (around some areas) – CQM and Reporting Alignment
and Requirements
Provide Guidelines and Milestones
Acknowledge and Support Work as Iterative Process
CONTACT INFORMATION
32
Randall Reitz, [email protected]
Mike Olson, [email protected]
Alex Schmidt, [email protected]
Shi Lynn Coleman, [email protected]
Stephanie Kirchner, [email protected]
Heather Stocker, [email protected]
QUESTIONS
33
