A key part of our Colorado SIM project is sustainability of integrated primary care and behavioral health services after the end of the award period. Our program will likely not be sustainable without payment model reform. Continuing the fee-for-service approach to paying for these healthcare services will not lead to long term, sustainable integration because of inherently misaligned incentives they may create. Our payment model reforms will reflect multi-payer, multi-stakeholder input that will be sought out and obtained during the pre-implementation year as well as ongoing input and learning during the test years. Options will likely be developed that allow for different levels of provider readiness, different structures of integration, and differences in geography across the state.
This July 2015 report focuses on criteria for success for of payment model reforms, transitioning options for different practices, and plans for implementing the various models and methodologies in Colorado during the pre-implementation period and test years.
Criteria for Successful Healthcare Payment Reforms
The SIM project cannot expect providers of the integrated services to attempt to achieve the Triple Aim (Improving the patient experience of care – including quality and satisfaction, improving the health of the state of Colorado population, and reducing healthcare costs) if our payment system does not provide sufficient financial payment to accomplish these goals and support for provider efforts. This is regardless of their motivation to accomplish the SIM goals. As well, it is alsomay be unrealistic to expect Colorado Payers to be willing to pay more or differently for integration without som...
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...ities to manage their practices under alternative payment approaches and systems, and their abilities to implement changes during practice transformation. Flexibility, accountability and adequacy will be key to success with achieving high quality care and outcomes at affordable cost. We will customize the payment models through proactive discussions with the providers and payers, incorporating aspects of the unique markets across Colorado.
Additionally, the different options described above will help both providers and payers incrementally transition from the current fee-for-service system to better payment models over time. Some providers and payers may be able to more rapidly make transitions than others, managing bundled payments and accountability mechanisms during the first test year. The spectrum of payment model reforms can be seen in the transition grid below.
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