Rocky Mountain Health Plans collaborates with Western Slope physicians to promote service integration
Kevin R. Fitzgerald MD, Patrick Gordon, MPA and Lori Stephenson, RN, Rocky Mountain Health Plans
For nearly 40 years, Rocky Mountain Health Plans (RMHP) has collaborated with physicians and community organizations on the Western Slope to create access, quality and health equity for commercial, Medicaid and Medicare patients – as well as for the uninsured. Built by physicians in the early 1970s to address issues associated with government programs, RMHP is one of very few health plans to enroll Medicaid members in Colorado. Changes ahead with the pending Medicaid expansion and subsidized coverage through the Colorado health insurance exchange will necessitate even greater health services integration if we hope to maintain a high level of quality and social equity in access to care. Fortunately, this change is already well underway on the Western Slope, and is taking shape in collaboration between RMHP and physician practices and networks to accelerate transformation of the system.
RMHP’s work in this area began more than 10 years ago, when the health plan in collaboration with local physician organizations implemented its first program to comprehensively address chronic disease and create useful patient registry functionality. One of the first of its kind in Colorado, this program received national recognition and served as a model for other programs in this state.
Two years ago Rocky collaborated with a local IPA (Mesa County Physician’s Independent Practice Association), a regional medical center (St. Mary’s), a business and civic leadership association (Club 20), and a nationally recognized regional health information network (Quality Health Network) to obtain a $12 million federal investment for an initiative called Beacon. These funds were utilized to expand the development of health information technologies and to improve the coordination of services and population health management at the point of care.
By learning new skills and adopting new tools, several participants achieved success in validating performance baselines and making rapid, longitudinal improvements within their patient panels. More importantly, the lessons learned and shared through large-scale, collaboration enabled participants to create closer connections with their patients, and position themselves for more complex activities such as comprehensive care management. The experience was so valuable that RMHP and several of the participants moved forward to create broader opportunities for practice transformation, collaborative learning and payment reform.
For instance, RMHP aggressively pursued participation in the Centers for Medicare and Medicaid Innovation Centers Comprehensive Primary Care initiative (CPCi). CPCi enabled western Colorado providers to capitalize on the Beacon work, by leveraging substantial new funding from RMHP, other private payers, and Medicare and Medicaid to invest in the infrastructure required to create a new system of care and to begin to study the move away from the volume-driven fee-for-service payment.
RMHP was also designated technical assistance contractor for CPCi on the Western Slope (the only health plan in the nation to receive this designation), and extended its commitment to employ personnel for practice transformation and EHR data extraction and reporting specialists to more effectively support practices as they take on the difficult work of advanced transformation.
In addition to the practices with which we are collaborating within the CPC effort, we have also developed an expanded system to create an “on ramp” to transformation through a new program called Foundations (the former Beacon program). Foundations is a program curriculum designed to provide practices with foundational knowledge and experience with quality improvement principles. Graduate practices of the Foundations curriculum can continue their work in our Masters 2013 program. This program focuses on the transformation techniques established in the Foundations program but incorporates more rigorous objectives regarding management of patients that are high risk with a care team approach. Both of these programs are supported with Rocky staff and include some financial incentives from Rocky to accelerate learning and off set the cost of transformation within the practices.
RMHP sponsors ongoing quarterly learning collaboratives that enable participants to share experiences, problem-solve and form the relationships necessary to create a sustainable medical neighborhood. The geographic outlay of these programs has expanded from the initial seven counties in which the Beacon program operated to include practices throughout the entire Western Slope.
“Participation in the Beacon program provided additional resources to our practice in terms of quality improvement coaching and health information technology training,” said Gregory C. Reicks, D.O., F.A.A.F.P., family physician at Foresight Family Physicians in Grand Junction and president of the Mesa County Physicians IPA. “The quality improvement coaching helped transform our practice into a continuous quality improvement organization using proven strategies for implementing and sustaining change. The health information technology resources helped us to better understand the full capabilities of our electronic health record and develop an interface with our health information exchange to allow better sharing of data across our community.”
“The end result is better quality of care for patients and greater satisfaction of our staff and providers. The additional funding coming into our practice through CPCi will allow us to expand our resources further in terms of care coordination, health coaching, patient engagement and activation tools, which we believe will improve outcomes in our patient population.”
Global payment models
RMHP recognizes that behavior is the key driver in both health and future costs. As such, we are investing in new global payment models to accelerate the integration of behavioral health services in primary care and community settings, in partnership with academic and policy partners at the University of Colorado, Collaborative Family Health Care Association and various physician practices. Lessons learned in this effort and the transformation underway throughout our system will soon enable us to expand a truly complete and sustainable model of comprehensive care.
RMHP’s overall goal is to actively support the development of the skills, technologies, workforce, and professional relationships necessary to create an accountable care community, in which all local organizations work independently – well outside their own walls and platforms (and the realm of health care itself) – to achieve a healthier and more economically-competitive community. We remain committed to effectively supporting our physician partners and being an open, active, collaborative part of the solution in health care.