By Katie Kerwin McCrimmon
Colorado has won a $65 million federal grant to dramatically increase the number of patients who can access blended care for medical problems, mental health challenges and substance abuse treatment.
“This is a watershed moment in Colorado health policy,” said Sue Birch, head of the state’s Medicaid agency, the Department of Health Care Policy and Financing, which now provides government–funded health coverage to nearly 1.2 million patients. “We will be moving ahead quickly to balance the health and well-being for Coloradans.”
Colorado had applied for $87 million and won the smaller award, but leaders hope to try to raise additional funds and still reach a broad swath of the state’s population. Altogether, the federal Centers for Medicare and Medicaid Services on Tuesday handed out $620 million to 11 states in a second round of grants. Like “Race to the Top” funds in education, the “State Innovation” program aims to jump-start and expand efforts that improve quality, while boosting health and saving money in health care. To see the list of the latest winners, click here.
Patients with private health insurance will benefit along with those covered through Medicaid and Medicare. The grant funds aim to reach 80 percent of Coloradans through integration efforts at 400 medical and behavioral health practices by 2019. All the state’s private insurance carriers have agreed to participate in changing the way they reimburse providers so patients can receive integrated care.
“This is our trellis moment,” said Ben Miller, a national expert on physical and behavioral health integration, a clinical psychologist and director of the Eugene S. Farley Jr. Health Policy Center at the Department of Family Medicine at the University of Colorado Denver School of Medicine.
Various integration pioneers across Colorado have been trying to weave together medical and behavioral health, but it’s hard to afford and there’s been no unifying spark until now.
“We have all these vines going in different directions,” Miller said. “Now they can grow together and we can have a much greater collective impact.”
Miller happened to be at a meeting of integration experts in Washington, D.C., on Tuesday when news of the grants was announced. He said some states are pushing for practice change to promote integration, while others are trying to change the way providers get paid. The new Colorado effort will be groundbreaking in that it will push for integrated care and new payment systems at the same time on a grand scale.
“We can take all the lessons that have been learned and go from 18 or 19 practices to 400,” Miller said. “This is unbelievably momentous for Colorado. It’s huge because it shows the rest of the country that we can actually integrate.”
Colorado had previously received a $2 million planning grant. So the new program known as SIM for State Innovation Model is ready to roll out.
SIM program director Vatsala Pathy said that as the effort matures, patients should see changes.
“Hopefully a lot of things will look different. If you’re a patient walking into a clinic to receive care, the provider (will be) thinking of all aspects of your health, not just the issue you came in for,” Pathy said.
She described one physician’s account of a patient who kept coming in for ailments that perplexed the doctor.
“The patient had all these physical complaints and the doctor couldn’t figure out what was going on,” Pathy said.
Finally after several visits, the doctor unearthed the patient’s root problem.
“He was drinking a bottle of whiskey every night,” Pathy said.
An earlier visit with a behavioral health provider could have exposed the addiction problems sooner.
In the future, patients should be able to see various providers under one roof and insurance companies might pay the care team for efforts like regular “huddles” to map out the best treatment plans for an individual patient.
Mental health and substance abuse problems often lead to poor medical outcomes, hiking costs for care across the board. Better integrated care aims to improve health and save money.
The new grant will also allow for new IT systems that should give muscle to even the smallest providers. For example, doctors in a small family practice setting could get data to see how all their diabetes patients are doing and how improved monitoring might keep patients healthier.
At the same time, regions in the state should be able to get data highlighting how they are doing on key health issues like prescription drug abuse or overdoses.
“Providers and communities could look at trends like a spike in ER visits related to drug ODs and see what’s going on. What do we need to do to figure out what’s going on in our community with substance use,” Pathy said.
At the moment, most primary care providers are too overwhelmed with short appointments and large patient loads to be able to probe more deeply into why some patients have such poor health.
In other cases, nurses or care coordinators might be able to make connections they couldn’t before during a short doctor’s visit.
“It could be anything from food insufficiency and being hooked up with a food bank … to being depressed because you’re bereaved and lost a loved one and don’t have access to a grief support group,” Pathy said. “This touches everybody: providers, physicians, as well as other members of the care team, nurses, psychologists, insurers and health IT organizations.
“It allows us to have a person-centered approach to care and not a system-centered approach. How do we create a health care system that meets all the needs a person has?” Pathy said.
Birch, the Medicaid director, said the grant will allow a major culture shift.
“As a nurse, we sometimes see clients coming in for numerous visits for headaches or lower back pain or diffuse joint pain. We might throw a lot of traditional medicine at them — pills. In the future, we’re going to be better about trying to understand the root cause of this pain.
“What are the stressors that are exacerbating these conditions?”
Birch said everyone should care about integrated care, both so they and their loved ones can get better health care, but also to cut costs.
“We want to do more value-based services, not more volume,” Birch said. “The more that we deliver … over-medicalized health care, the more we waste, the more we lose.”