Colorado Community

Colorado Health Plans make Expanded Commitments to Integrated Care and State Innovation Model

Author | Shield HealthCare
06/25/15  4:11 PM PST
Colorado Health Plans

DENVER, June 23, 2015 /PRNewswire-USNewswire/ — The Colorado State Innovation Model (SIM) project is pleased to recognize the significant commitments made by six Colorado health insurers and the state’s Medicaid program to adopt delivery and payment reforms designed to integrate behavioral and physical healthcare.

“These commitments represent an important step forward in furthering the goals of the SIM initiative,” said Vatsala Pathy, SIM Director. “These plans were individually crafted by each payer to fit their business platforms and systems, and done so voluntarily. Their commitments to these reforms are especially impressive given the competitive nature of Colorado’s insurance market.”

“Transformational change in the way healthcare is delivered and paid for cannot happen without payers being on board and we are thrilled to have such a strong commitment from these forward-thinking healthcare leaders,” Pathy said.

The changes that each of the six health insurance companies and Medicaid agreed to implement are aligned with and support SIM, an ambitious effort to integrate medical and behavioral care and ensure payment structures are in place to make that happen.

In December, the state received a $65 million federal grant and engaged in a cooperative agreement to carry out the goals of SIM. The initiative is providing financial and technical support for the development and testing of payment and service delivery models that will improve health system performance, increase quality of care and decrease costs.

The healthcare insurers who have made these transformational commitments are:

Anthem Blue Cross Blue Shield, Cigna, Colorado Access, Colorado Choice Health Plans, Rocky Mountain Health Plans and UnitedHealthcare. Colorado’s Medicaid program also is changing practices in similar ways.

“Supporting integrated care and the State Innovation Model is part of our ongoing effort to invest in the primary care doctor-patient relationship and help Coloradans live their best lives possible,” said Mike Ramseier, President of Anthem. “Programs like this are fundamental to Anthem’s mission to lower health care cost while delivering high quality care, which is why this will be our new way of contracting with all primary care providers going forward.”

Anthem has a longstanding history of supporting the integrated care model, starting with the Colorado Multi-Payer Patient Centered Medical Home pilot and evolving into its own Enhanced Personal Health Care program for primary care in Colorado. Anthem already has close to 60 percent of its primary care physician network in arrangements that support whole-person care. The program represents a significant investment in primary care that allows physicians and their practice team to do what they can do best: manage all aspects of their patients’ care to include behavioral health. Anthem will continue to expand its existing Enhanced Personal Health Care Program for Primary Care in Colorado over the coming months and is recruiting close to 35 additional physician practices in Colorado by Oct. 1, with most of the recruitment focused in rural areas.

“We look at people holistically – which means supporting their physical and mental well-being. In fact, nearly all of our employer clients in Colorado have both behavioral and medical services through Cigna,” said Kim Bimestefer, president and general manager for Cigna’s Mountain States Region. “This allows us to improve health, reduce costs and enhance the overall experience for individuals. We look forward to working with Gov. Hickenlooper and his team to expand integrated care across the state.”

Cigna has been a leader in behavioral health for decades, with more than 23 million behavioral health customers across the U.S. The company is pursuing innovative solutions that give primary care physicians access to support and experts who can diagnose, refer and treat individuals with mental health, substance abuse and related behavioral issues. Cigna is increasing its commitment in Colorado by emphasizing care coordination and by rewarding physicians for quality of care, instead of volume of services. As of Jan. 1, 2016, Cigna will have more than 40 percent of its customers in Colorado cared for by physicians in collaborative care arrangements. This represents more than 300 practices in Colorado.

“When we work together as payers and providers to transform the delivery of care, we can make a real difference in the lives of families and communities,” said Marshall Thomas, Colorado Access President and Chief Executive Officer. “At Colorado Access we strive to promote patient-centered care.  In order to care for the whole person we have to provide integrated services at the time and place that is most convenient for the patient. We are proud to support the State Innovation Model.”

Likewise, Colorado Access, a nonprofit health plan supporting more than a million Coloradans with access to healthcare, will be a key driver of increased integration, team-based care and primary care practice supports. For 20 years, Colorado Access has partnered with provider organizations and systems to offer integrated care models in both primary care and specialty mental health settings. With a large percentage of Colorado Access members accessing both physical and behavioral healthcare services simultaneously, the company has developed expertise in person-centered and integrated care delivery. More than 200 primary care practice sites are already working with Colorado Access to deliver team-based care. Of those sites, 118 are already offering or attempting to develop on-site behavioral health services.  The mission-based company will continue to promote and actively support the integration of care delivery, especially for those with acute behavioral health needs. In 2015 Colorado Access is intensively working with more than 50 primary care sites to deliver enhanced integrated care services including innovations like telepsychiatry, onsite behavioral health clinicians and new payment models.  The company will continue to work with all contracted primary care practices to help them begin to deliver integrated care services or further enhance the services they are already offering.

“We’re excited to support this much needed integration of primary care and behavioral health into rural communities. Rural communities often get overlooked when it comes to innovative models that require commitment on new reimbursement methodologies for sustainability,” said Cynthia Palmer, Chief Executive Officer of Colorado Choice Health Plans.

Colorado Choice Health Plans has served the communities of Colorado by providing competitively-priced, quality health benefit plans to employers for over 40 years. Colorado Choice is a not-for-profit company that specializes in serving rural and underserved communities in south central Colorado and on the eastern plains.

Building on this mission, Colorado Choice will extend its commitment of enhanced payments to the four rural CPCI practices they currently partner with. In addition, Colorado Choice will more than double the number of rural practices receiving enhanced payments for advanced practice primary care and/or behavioral health integration. Colorado Choice will do this by supporting six additional practices in rural, underserved areas in southern and eastern Colorado that are striving for advanced practice primary care and/or behavioral health integration. This commitment to the expansion of the number of practices receiving enhanced payments will take place beginning in November 2015.

“Behavior is a major factor in overall health.  We need to close gaps and make it easier for people to access behavioral health services wherever they receive care – and when they need it most,” said Steve ErkenBrack, Rocky Mountain Health Plans’ Chief Executive Officer.

Rocky Mountain Health Plans, founded more than 40 years ago as an independent, not-for-profit headquartered in Grand Junction, is expanding its longstanding mission to improve access to high quality care as well.  Building upon a wide array of practice support, technology and community investments, and innovative payment programs, RMHP will broaden its Global Payment initiative by extending integrated behavioral health agreements in up to ten pediatric, family medicine and community health center clinics throughout Western Colorado, beginning in July. In this model, behavioral and primary care providers are encouraged to practice on integrated teams – not pigeon-holed into distinct “physical” and “mental health” silos.

“Colorado is ahead of the curve when it comes to innovative solutions that drive modernization and new approaches to health care,” said Beth Soberg, President and Chief Executive Officer of UnitedHealthcare of Colorado. “In conjunction with other health plans, Gov. Hickenlooper’s office and our colleagues at the SIM Project, UnitedHealthcare of Colorado is committed to the mission of improving whole health and affordability of care across Colorado. This is the next step in delivering on that mission.”

UnitedHealthcare serves more than 1.1 million people in Colorado with a network of 107 hospitals and 20,300 physicians and other care providers statewide. UnitedHealthcare will expand its enhanced care management program to approximately 93 Colorado Primary Care Physician practices in the metropolitan areas of Colorado. This expansion will take place beginning in July.

“Today was a significant step forward for Coloradans who will benefit from the integration of physical and behavioral health,” said Susan E. Birch, Health Care Policy and Financing Executive Director. “We understand the connections between mind and body, and integration of behavioral health with physical health services is a critical need for Colorado and our nation.”

Colorado Medicaid has taken important steps toward integration of physical health over the last several years. These efforts are fully aligned with SIM. Colorado has invested in practice transformation since launching its Accountable Care Collaborative program in 2011. This fiscal year alone, Medicaid has invested more than $19 million in Per Member Per Month payments to providers and more than $75 million in payments to Regional Care Collaborative Organizations (RCCOs) to help them achieve transformation and for meeting quality metrics. As of May 2015, about half of all Primary Care Medical Providers in the ACC (about 270 practice sites) have been validated as meeting the standards for enhanced payment.  These practices serve over 500,000 ACC clients statewide.

Colorado was recently awarded a $65 million grant by the U.S. Department of Health and Human Services to create a coordinated, accountable system of care that gives Coloradans access to integrated primary care and behavioral health. The state will use the funding over the next four years to implement a State Health Care Innovation Plan with a focus on improved integration of physical and behavioral health services.  Colorado Gov. John W. Hickenlooper has established four major goals for the effort:

  • To create a coordinated, accountable system of care that gives Coloradans access to integrated primary care and behavioral health.
  • To leverage the power of our public health system to achieve broader population health goals and support delivery of care.
  • To use outcomes-based payments to enable transformation.
  • To engage individuals in their care.


SOURCE State Innovation Model


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