This post is the first of a five part series highlighting states across the US that support integrated care initiatives. Check back later for more posts.
Every so often, an opportunity comes along in healthcare that must be pursued. These opportunities often build off the recognition that there is: a) a problem; and, b) a solution, that while difficult, could be pursued to address the problem. The state of Colorado is currently in the process of pursuing an innovative solution to a longstanding problem; however, before I get to that, let me start with some context.
Fragmentation in healthcare has led to a place where we spend more and get less. While there are many examples of where fragmentation is problematic in healthcare, there is no more prominent example than in the artificial separation of the so called "mental health” from the so called "physical health.” Years of stories, backed by data, support the need for us to treat the whole of health rather than pieces. Specific to many exciting initiatives, integrating behavioral health services into primary care truly creates a more patient-centered and community friendly approach that can help achieve the Triple Aim (decrease cost, improve outcomes, and enhance the patient experience).
What is integrated behavioral health and primary care you may ask? According to the Agency for Healthcare Research and Quality (AHRQ) Lexicon for Behavioral health and Primary Care Integration:
"The care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address mental health, substance abuse conditions, health behaviors (including their contribution to chronic medical illnesses), life stressors and crises, stress-related physical symptoms, ineffective patterns of health care utilization.”
Colorado, not wanting to play politics with people and rest on its laurels, has decided to aggressively pursue a strategy that sets it head and shoulders above the rest of the country in its level of innovation. You see, many states have decided they have got to do something about healthcare cost. Some states expand Medicaid; some don’t. Some states have the best intentions to do something beautiful only it doesn’t quite work out.
Colorado has decided to integrate behavioral health into 400 primary care practices. Yes, I said 400. This is no goal to balk at, but what would you expect from a state whose lowest elevation is 3,315 feet? We live a mile high and aim our healthcare goals even higher. This "State Innovation Model” (SIM) is just another innovation in an already innovative state around healthcare. But unlike other healthcare initiatives, SIM, at its core, is about payment reform. Payment reform that can support integration through practice transformation.
And no, it is not just like riding a bike. You see, like unlearning how to ride a bike, Colorado has to literally unlearn how to deliver fragmented care. We have to set aside all our culture, history, politics, and antiquated protectionist tendencies to do what’s right for people. For some, mainly our communities, this will change lives. For others, like some of the special interests who love to protect their pot of the pie, there will be "much rejoicing.”
This is transformation at its finest.
Will we succeed? I believe so, but in order to answer that question, we have to try first. We have to create a framework by which our state can pursue integrated efforts. We have to bring people together to have our "trellis moment.”
Here are the top three reasons why I believe Colorado is leading the nation in healthcare innovation:
We do not have a dominant payer (hint: can help increase competition amongst payers);
We have the support of our state (including our Governor who created an entire office around integration through an executive order); and,
We have an engaged community.
As we all know, to truly transform healthcare, we have to change it clinically, operationally, and financially. We have to look at the state policy levers that enable change and pursue them with reckless abandon.
Make no mistake, Colorado’s reputation as a leader in healthcare is cemented through such forward thinking ideas as that of the SIM. With strategic partners, including health plans, Colorado has a chance to successfully create an approach to healthcare that is person-centered, remains focused on the whole, and is committed to seeing that investment reap positive benefits from all who participate.
So can Colorado right a wrong when it comes to separating out behavioral health from the larger health system? Possibly. But for SIM to be a success it will require a fundamental departure from legacy systems and antiquated ways of delivering and paying for healthcare. Because after all, isn’t the notion of integrating behavioral health into primary care just another example of good care? Regardless, you will be hard press to find another state that is leading the way like Colorado.
|Dr. Miller is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. He leads the Agency for Healthcare Research and Quality’s Academy for Integrating Behavioral and Primary Care project as well as the Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) project in Colorado and Oregon. He is the co-creator of the National Research Network’s Collaborative Care Research Network and is the past President of the Collaborative Family Healthcare Association. He is the section editor for Health and Policy for Families, Systems and Health and reviews for several academic journals. Dr. Miller is a technical expert panelist on the Agency for Healthcare Research and Quality Innovations Exchange and on the International Advisory Board of the British Journal of General Practice. Dr. Miller’s research interests include models of integrating mental health and primary care, health behavior interventions, primary care practice redesign, using practice-based research networks to advance whole person healthcare, and healthcare policy.