Abstract
Thanks for funding from the Center for Medicare and Medicaid Innovation (CMMI), the state of Colorado soon will implement and test its proposed model for healthcare innovation, entitled “the Colorado Framework.” This article discusses how and why the model, integrating primary care and behavioral health as its cornerstone, creates a system of clinic-based and public health supports to spur innovation and healthcare cost savings. It also describes the current healthcare delivery challenges in Colorado and how payment model reforms – including capitation, risk adjustment and gain sharing – are necessary to achieve sustainability
Insights Results
Overview of article/framework
This article discusses how and why the Colorado Framework, a State Innovation Model (SIM), creates a system of clinic-based and public health supports to spur innovation and healthcare cost savings. Also describes the current healthcare delivery challenges in Colorado and how payment model reforms are necessary to achieve sustainability
The goal of the Colorado Framework is to have 80% of Coloradans have access to integrated behavioral healthcare in primary care settings by 2019
The Colorado Framework creates a system of clinic-based and public health supports to spur innovation.
Key components: 1) Provides access to integrated primary care and behavioral health services in coordinated community systems; 2) Applies value-based payment structures; 3) Expands information technology efforts (e.g., telehealth); and 4) Finalizes a statewide plan to improve population health
The integration of primary care and behavioral health is the cornerstone of the model as the state believes that coordinated, accountable systems of care begin with primary care and expand from there
Key takeaways/implications
SIMs should be designed to achieve certain goals: 1) Appropriate flexibility in care delivery across the state; 2) Appropriate accountability for all spending; 3) Appropriate accountability for healthcare quality; and 4) Payment adequacy for providers
To avoid payment reform design from being incomplete, the following items should also be considered: 1) Definition of services to be covered by each provider payment; 2) The approach to controlling utilization and spending; 3) The approach to ensuring good quality and outcomes; and 4) The approach for ensuring payment adequacy for providers
