Opinion: SIM — What’s all the excitement about?

By Kristin Paulson

On Dec. 16, the staff at Center for Improving Value in Health Care spontaneously started yelling and dancing. No, we were not celebrating the holiday season with synchronized glee. Nor were we working on “Colorado APCD: The Musical.” We were throwing a party because the long awaited Centers for Medicare and Medicaid Innovation State Innovation Model (SIM) Round 2 funding awards were released and two long years of work were being rewarded.

Kristin Paulson

Kristin Paulson

Colorado was awarded $65 million dollars to implement the Colorado state innovation model and was one of only 11 states awarded dollars to fund implementation of a statewide plan. While we here at CIVHC have been living and breathing SIM for the past two years, it might not be as familiar to all of you. Let me give you a brief history of the work that has been put into SIM and so you can see why we’re so excited.

In 2012, the Centers for Medicare and Medicaid Innovation (CMMI) released a funding announcement for the first round of State Innovation Models. States were given eight weeks to design a model for innovating health care across their state. Colorado submitted an application for the first round of funding that was focused on the integration of behavioral health into the primary care setting, and was promptly turned down. CMMI felt that though we had some great ideas, we hadn’t fully thought things through and needed to work on further developing our plan. They did give us $2 million dollars to engage stakeholders and flesh out the plan into a large scale, long-term state innovation plan to be completed by the end of 2013.

After nearly a year of hard work and extensive research from partners across the state, Colorado completed the innovation plan and submitted it into CMMI. The plan was still based on the idea of bringing behavioral health care into the primary care setting, but it now included information about how public health and information technology would be developed to support the new model, how payment models would change to support integrated care, and how patients and practitioners would work together to improve health care and reduce costs across the state.

After the innovation plan was submitted (400+ pages), the team assembled to create the plan reconvened and added stakeholders from a broader swath of the health care continuum. We worked for months to continue developing the ideas we put together, knowing there would be another round of funding available, which was released in May 2014. In round 2, CMMI was looking for a more robust role for public health and firm commitments to participate from providers and payers alike. Armed with a project manager, the SIM team again engaged a wide group of stakeholders and worked to enhance the original application to include the following key elements:

• Bidirectional care addressing the need for primary care services in behavioral health settings as well as behavioral health in primary care,
• More consolidated approaches to data and reporting,
• Clearer picture of how to modify reimbursement to support the model, and
• Increased flexibility to allow for community-level decision-making.

After a lot of work, the SIM team was able to create a strong proposal that brought together the biggest ideas into a comprehensive approach to changing health care and secured letters of commitment from over 100 different organizations. If funded, the plan we all contributed to would result in better health for all Coloradans over the four years of the program.

Then, the award announcement on Dec. 16 gave Colorado $65 million dollars to actually start implementing our statewide plan to change the way we deliver and pay for health care.

While we definitely want to celebrate this huge step forward, now is when the real work begins. CIVHC and many of our partners are working diligently to turn the proposal into actionable steps that can start to move the needle on population health measures and overall cost. We will be using the claims data from the Colorado All Payer Claims Database to track costs and utilization over the course of the program and support the 400 participating practices that will be working to integrate behavioral health into a primary care setting.

There are a lot of moving pieces in this undertaking and a lot of people that are involved on the front lines, but we’re starting to see things take shape as the grant officially kicks off.

If you’d like to learn more about what was included in the plan, what the application proposed and what is happening in the SIM world, tinformation is available on the website: www.coloradosim.org.

Feel free to contact me as well if you have any questions on CIVHC’s involvement and the role of the CO APCD in achieving the vision of Colorado’s State Innovation Model.

Kristin Paulson is CIVHC’s senior manager of policy and initiatives. Contact her at [email protected].

Opinions expressed in Health News Colorado represent the views of the individual authors.

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