State Innovation Model
SIM helps providers move beyond the theory of health reform
by Heather Grimshaw, Communications Manager, SIM
The Colorado State Innovation Model (SIM) closes its third and final application (bit.ly/sim3application) for cohort 3 on Jan. 19. This governor’s office initiative, which is funded by the Centers for Medicare and Medicaid Services, helps Colorado primary care practices integrate behavioral and physical health, and test alternative payment models.
The initiative launched with 100 practice sites and four community mental health centers in 2016, expanded in 2017 with 155 practices in cohort 2 and will help a total of 400 primary care sites and four community mental health centers deliver whole-person care by the end of its four-year time frame in July 2019. These three cohorts will integrate physical and behavioral health with support from SIM; they represent about 25 percent of the primary care practice sites in the state. The work the first two cohorts and the community mental health centers are doing to integrate behavioral and physical health affects close to 700,000 patients.
“Our SIM initiative enables providers to move beyond the theory of health care reform and implement meaningful change that improves patients’ lives and avoids unnecessary costs,” said Gov. John Hickenlooper.
Perhaps one of the greatest benefits to SIM participation is the knowledge that addressing the whole patient is the right way to deliver primary care.
“It’s energizing to give the kind of care you envision instead of being frustrated every day,” said a SIM cohort 1 physician. “Somewhere in your gut you feel like, ‘God, I could do better.’”
A few successes from cohort 1 practices:
- Increased mental health screenings: Practices screened 215,659 eligible patients for depression; followed-up on positive results
- Decreased burnout
- Improved ability to report and confidence in clinical quality measures (CQM), data that can help providers articulate a unique value and negotiate more effectively with health plans
- Example: In the second quarter of 2017, 100 percent of SIM practices reported on at least one CQM
- Improved integration: Of 92 cohort 1 practices, 39 moved to a higher level on the Integrated Practice Assessment Tool after a year of SIM participation (42.4 percent): http://bit.ly/2ijUWai
SIM will provide cohort 3 practices with a year of on-site coaching from clinical health information technology advisors and practice facilitators ($25,000 value), financial support that includes a $40,000 small grant opportunity, and access to a data aggregation tool that helps health care teams evaluate and improve processes using cost and utilization data. Get a full list of benefits: http://bit.ly/2zVdaVl.
“The goal of SIM is to help providers gain valuable skills to help them collect, report and use data more effectively,” said Lt. Gov. Donna Lynne and SIM chief operating officer. “This information helps them provide improved patient care and successfully negotiate contracts that reward the value (not volume) of care delivered.”
Articulating unique value
The shift from fee-for-service to value-based contracting is still new for a lot of providers, which is why the coaching and guidance provided with SIM funding is so valuable.
One illustration of how SIM prepares practices for success with alternative payment models: SIM practices designated as primary care medical providers in the Health First Colorado (Medicaid) Accountable Care Collaborative will have a “glide path” to participate in the new alternative payment model (APM): http://bit.ly/2krl0AY. SIM practices will not have to submit quality measures for the first performance year (2019) of the Health First Colorado APM and will receive full credit on the APM point scale for their participation in SIM.
Health First Colorado is one of seven payers that support SIM practices with APMs that are negotiated directly between practices and payers. Read more about payment support: http://bit.ly/2CE9b4p.
The SIM initiative helps providers progress along an integrated care path continuum that might start with referrals and could lead to co-location of behavioral and physical health professionals in primary care settings. Integrated care improves patient outcomes, reduces health care costs and enhances provider morale. About 1,847 SIM providers in cohorts 1 and 2 are delivering integrated care during approximately 3,342,018 annual patient visits.
Colorado was one of 11 states selected for the SIM model test awards, and the only state to focus on integrated care supported by public and private payers as its primary goal. The state will receive $65 million from the federal CMS to implement and test its model for health care innovation. It is expected to save or avoid $126.6 million in health care costs for the agency with a 1.95 return on investment during its four-year timeline.
- Benefits to participating in SIM: http://bit.ly/2zVdaVl
- Integrated care continuum: http://bit.ly/2lVjk2l
- Practice transformation articles: https://www.colorado.gov/pacific/healthinnovation/ptseries3
- Glenn Madrid, MD, talks about his involvement in SIM: https://youtu.be/ol6NbNLp0tQ
- Cohort 3 information: http://bit.ly/2j3hA6j
Posted in: Colorado Medicine | Practice Evolution | Practice Redesign | Health System Reform