Six Colorado health insurers, as well as the state's Medicaid program, have voluntarily joined forces to better integrate behavioral and physical healthcare by aligning on payment measurement and data sharing under a common framework.
The effort follows Colorado’s recent $65 million federal grant, awarded in December, to create a State Innovation Model that makes behavioral health a top priority.
State Innovation Model (SIM) grants are specifically awarded to state governments to help them test new payment and delivery models across multiple payers.
The involved payers in Colorado were already working together under the Centers for Medicare & Medicaid Services’ Comprehensive Primary Care Initiative, which incentivizes payers to help strengthen primary care, so the SIM efforts simply built on that structure, Vatsala Pathy, director of the State Innovation Model, tells Healthcare Dive.
“The plans are using existing proprietary initiatives to help support and advance efforts around integration,” she says, helping practices achieve new competencies and advancing value-based payment.
The six payers are Anthem Blue Cross Blue Shield, Cigna, Colorado Access, Colorado Choice Health Plans, Rocky Mountain Health Plans and UnitedHealthcare, as well as Colorado's Medicaid program. Representatives meet monthly, sometimes in person and sometimes by phone, to discuss their shared goals.
Some of their strategies include incentive payments to providers for improving care coordination; a centralized process to help providers connect with behavioral health specialists; and providing mini-grants to help practices hire behaviorists. They also aim to combine their claims and clinical data to gain better insights and ultimately further transform care.
While a number of states are undergoing related efforts through SIM grants, Pathy notes that the work in Colorado is unique because the state has a particularly diverse health insurance market, rather than a market highly dominated by just one or a few commercial plans and the state Medicaid plan. “We have a much bigger table… it’s a different conversation when you have fewer payers than when you have more,” she says.
She adds, “All of the SIM states are doing a version of this, but I would venture to say that we have one of the more mature multi-payer collaboratives in the country.”
The strategies in Colorado could lend themselves to payers in other states, Pathy says. Her main takeaway is that building relationships and trust among the participants has led to opportunities for shared learning, and for the participants to explore additional ways to work together outside of the specific initiatives that brought them together.
The conversations include how the participants actually implement strategies, to their barriers and experiences. “It’s a really rich conversation to have that across plans,” Pathy says.
Patrick Gordon, associate vice president of Rocky Mountain Health Plans, told Hospitals & Health Networks that it was initially difficult to sit down with competitors, but that once things got underway, the effort clicked. He said it was persuasive for payers to join forces because they had previously seen savings from collaborations under the Comprehensive Primary Initiative, where they concluded that every $1 invested in primary care resulted in $5 in savings down the line.