Summit County clinics tapped to take part in state innovation project that seeks to provide integrated care
Skyrocketing health care costs and lack of provider accessibility in Summit County have long been problems in search of a solution. Now, under the federal government’s State Innovation Models (SIM) initiative, two local providers will be part of an experiment to see if a new approach — one that integrates behavioral and mental care with physical care — can work to improve accessibility while trying new payment models.
The Center for Medicare and Medicaid Services is funding up to $65 million for the four-year initiative in Colorado, which is experimenting with integrating behavioral and physical care as well as new payment models. Colorado is one of eleven states participating in the initiative, and the only one to test out integration of care.
The ultimate goal of the initiative is to be able to provide integrated care with value-based payment systems to 80 percent of Colorado residents, giving most people in the state equal, adequate access to whole-body care. In Summit County, High Country Healthcare in Silverthorne and Ebert Family Clinic in Frisco were chosen to take part in the 2nd cohort, or phase, of the initiative.
“SIM providers in these cohorts must focus on the entire patient, which means addressing mind, body and mental wellness,” said lieutenant governor Donna Lynne, a former health care executive. “That complete approach to health is what makes the SIM initiative is so valuable. Patients get the care they need when they need it, and providers learn how to succeed with new payment models. It’s a great example of meaningful reform in our state.”
The initiative will seek to build stronger pathways between primary care physicians and mental health care providers, with eventual co-location of care possible to make it easier for patients to get help for different aspects of care in the same place.
Colorado’s SIM initiative will also allow private practices such as Ebert Family Clinic in Frisco see patients with Medicaid or Medicare, which in many cases can lead to same-day care and better outcomes. Ebert is also using tele-health services to offer 24/7 care to anyone unable to get in-office care in time.
“At Ebert Family Clinic, we don’t turn anyone away, especially in a place that is as demanding when it comes to physical and mental health as Colorado,” said Meaghan Ziegler, practice manager at the clinic. “But this initiative will help with the financial burden for patients by allowing us to accept insurance from the large population on Medicaid or Medicare.”
Ziegler added that the program should lead to less instances of residents resorting to the emergency room for primary care, as there is at least one more primary care provider in the area they can see first if they have government-subsidized insurance.
The SIM initiative also uses alternative payment models to ensure providers get adequately compensated for their services while working to keep costs down. SIM strategy and policy manager Krysten Joyce said that no single payment model will be used, but there is a common goal of focusing on the value of care rather than volume by focusing on health outcomes rather than number of services provided.
“These alternative payment models are meant to incentivize value over volume so we’re not constantly stuck in the churn of endless additional tests and services,” Joyce said. “Alternative payment models are really starting to recotnize how practices are improving patient outcomes. In the long run, we hope they will reduce costs.”
Joyce added that the SIM initiative aims to be a benefit for everyone—patient, provider and payer—by being a liaison between all three and giving each part of the health care nexus what they need or want out of the process.
For more information about the State Innovation Model initiative, visit https://www.colorado.gov/healthinnovation.
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