Tracking SIM practice transformation efforts 
July 29, 2019
Passing the baton: SIM set the stage for future success

Time flies. The Colorado State Innovation Model (SIM) ends July 31 after achieving success across four pillars (practice transformation, payment reform, population health and health information technology), which expanded patient access to whole-person care. The small SIM team has championed your work with Governor Jared Polis and Lieutenant Governor Dianne Primavera, who cite examples of how your efforts to reform health care benefit patients, health plans and care team. You are truly health care innovators and it has been a privilege to work with you on this journey. Please check the SIM data hub this fall for final reports submitted to and approved by CMMI, final evaluation reports and more and use SIM resources as you continue your work.
Sustaining the SIM-funded eCQM solution

Management for the electronic clinical quality measure (eCQM) solution, which was funded by SIM to help practices report eCQMs once to multiple, approved entities, will transition to the Office of eHealth Innovation (OeHI) once SIM ends July 31. The solution has helped SIM practices finetune their processes for reporting and ensure that the data collected for reports reflects clinical interventions. Practices using the solution are encouraged to reach out to their Health Data Colorado partners with operational questions. Learn more about this solution: www.co.gov/healthinnovation/sim-ecqm-solution.
Medicaid APM: Next steps for SIM practices

The alternative payment model (APM) introduced by the Colorado Department of Health Care Policy and Financing (HCPF) provides a prime example of how SIM has prepared providers for success with reimbursement that rewards the value (instead of volume) of health care delivered.

"SIM was a catalyst for us to think about payment reform in Colorado," said Shane Mofford, director of rates and payment reform for HCPF, during the last SIM-funded Multi-Stakeholder Symposium in June. "Those who are participating in SIM and in CPC+ are doing what it takes to really advance the delivery system and we've acknowledged that by giving the providers credit in our payment models the first performance year."

While practices participating in SIM and the Comprehensive Primary Care Plus (CPC+) initiatives were not required to select measures for this APM for the 2019 performance year, SIM-participating practices must select 10 measures for the second performance year (2020) before Dec. 31. Practices participating in CPC+ get an additional year of credit in the APM model without the need to select measures this year. Click here to read more.
Asking the question: A step to improve veteran health

Stacy K. Syphers is connecting military veterans in eastern Colorado with community resources to improve their health and wellness, and she's developing a community-based plan to prevent suicide. Syphers was funded by SIM to do this work as a veteran health connector (VHC). 

One quick tip that she's giving primary care providers is to ask patients if they have served, which can influence health in myriad ways. Asking that one question could help care teams identify the source of a health issue more quickly and ensure better outcomes and the reduction of unnecessary costs. Hear more about this important work in the latest episode of the SIM podcast series, Innovation Insights, and check out the SIM website for more media.
New cost and utilization report released
 
Two practice-level reports will be published on the Shared Practice Learning and Improvement Tool by July 31 with new data. The new reports will include an additional six months of Medicare medical claims and an additional year of pharmacy claims. An additional two months of claims from commercial health plans as well as Medicaid and Medicare Advantage are included beyond data in previous reports. Attribution was updated based on this data so practice representatives might find additional lives not previously attributed to their practices. If you have questions about how to use these reports, contact Katie Matthews ( katie.matthews@milliman.com ) with Milliman before the end of the calendar year.
Continuing the push towards integrated care

The Colorado State Innovation Model (SIM) accelerated progress integrating care but the work's not done. As SIM concludes, industry partners are ready to keep the momentum going - together. There is still much to learn about the significant gains in integrated care that were made during the last four years. Colorado is Ready, and we need your expertise and commitment to continue to build.  Join the Colorado Is Ready LinkedIn Group to share your experience, s upport a new network and develop next steps together. The conversation starts Aug. 1, 2019.  #coloradoisready
Elevating awareness about integrated care with your patients

Start the discussion of whole-person health care with patients using this new handout created with SIM funding. Practices are encouraged to customize the flier by adding practice logos and the SIM office encourages you to print it out and put it at the front desk to raise awareness of the work you've done in SIM and the ways in which integrated or whole-person care improves patient health.
Broadband expansion extends patient access to care

SIM exceeded its goal of expanding access to broadband services for 300 rural health care sites during its four-year time frame. Using SIM funding, the Colorado Telehealth Network (CTN) helps eligible sites apply to the Healthcare Connect Fund, a federal funding stream administered through the Universal Service Administrative Company (USAC) to reduce the cost of broadband expansion for rural health care sites. SIM's goal for broadband expansion was exceeded by 27% and 381 health care sites received expanded broadband services over the lifetime of SIM. Learn more about SIM investments in health information technology: www.co.gov/healthinnovation/resources-health-information-technology
Preparing teams for success in integrated settings

Effective, sustainable redesign of primary health care includes resources for team members to work collaboratively in integrated environments. Competency based learning theory (CBLT), which is focused on the outcomes of learners, is delivered through active, interprofessional simulations and experiential learning activities.

Recent efforts, which emphasize the need for providers to work as interprofessional teammates, are grounded in the Core Competencies for Behavioral Health Providers Working in Primary Care developed through a statewide consensus project. SIM stakeholders contributed to and participated in development of these competencies and led efforts to raise awareness and use. Curriculum was aligned with the core competencies and delivered in person, through an eLearning platform and by accredited educational programs during the initiative. SIM encourages practice teams to take these free courses  and use this resource. Click here to read more.
Final SIM-funded Multi-Stakeholder Symposium

Lieutenant Governor Dianne Primavera attended the last, SIM-funded Multi-Stakeholder Symposium (MSS) June 6 in Denver, and thanked attendees for their investment in effective health care reform. 

"Redesigning health care takes time, energy and financial support and the people in this room have helped thousands of providers start or progress along that journey," Primavera said. "As a result, more than half a million more patients received whole-person care across that state and we want to see that number increase." 

These meetings prompted meaningful conversations between practices engaged in SIM and health plan representatives, who announced they will fund future meetings to continue conversations about payment reform. SIM funded the MSS to encourage representatives from SIM practices, health plans that support them and practice transformation organizations that coached practices to learn from each other, build closer partnerships, reflect on progress made to date and discuss challenges and successes. 

Read articles about how these meetings helped improve partnerships between health plan and provider representatives.
New page on website highlights SIM resources for providers

Get a list of resources customized for SIM-funded health care teams to help support work after the initiative ends. Please share these resources with your colleagues as they are available to all providers, regardless of SIM participation, and will be available after SIM ends July 31.
Business curriculum  for practices
 
Get help negotiating mutually beneficial contracts with commercial payers. Practice teams can access six, SIM-funded curricula and webinars, which provide an introduction to payer relationships and contracting, an overview of the most common reimbursement models used by health plans, strategies to use when contracting and tips for communicating effectively with health plans. Click here for more information.
Communicating the value of integrated care

The SIM office shared the final SIM Good Standing Report with health plans that support practices in the initiative last week. The SIM office worked with health plan representatives, who participate in the Multi-Payer Collaborative (MPC) to create a "good standing" process for primary care practices in cohorts 2 and 3 to illustrate the work required to integrate physical and behavioral health and provide patient-centered, team-based care. Practices achieve good standing by successfully completing identified building blocks and key milestones in the SIM framework. Read more.
Addressing the 'ouch' factor

By addressing patients' bodies and brains, SIM providers address what one patient advocate calls the ouch factor, which influences outcomes and reduces or avoids unnecessary health care costs. " It's uncomfortable to talk about and there are a lot of unknowns when it comes to our mental health," says Laura Carroll, honorary patient representative on the SIM advisory board. "We're just not comfortable talking about the ouches associated with mental health." Read more in the SIM blog   .
Educational series helps providers integrate care

A free ECHO series will focus on increasing provider competency in working with intellectual and developmental disability (IDD) dual diagnosis populations, who might be vulnerable to mental health issues. The series covers the evolution of dual diagnosis treatment, the diagnosis of mental health disorders in individuals with IDD, intervention considerations in dual diagnosis treatment and case discussions. Interested in more training opportunities? Be sure to check out the other free educational series from ECHO Colorado. SIM encourages professionals to also check the SIM-funded IDD module.
IBH 'best practice' training available

Short modules help primary care teams consider how the experiences of veterans and differences in hearing influence patient health. The modules help teams tailor approaches to meet the needs of veterans and people who are deaf or hard of hearing. All of the SIM-funded modules provide comprehensive, practical information about behavioral health integration in primary care practices for patients with specific care needs. Use these tools in team meetings for educational purposes and relationship-building, which contributes to higher-quality patient care. Sign-up for a free account using the "SIM" registration code to access these modules. These modules will remain available for at least one year after SIM ends.
Workshop opportunity

You're invited to the Health Technology and Innovation for Clinical Quality Improvement and Patient Engagement in Rural Areas workshop beginning Aug. 6. Click here for more information. 
e-Consults at Denver Health expand access and reduce costs

Denver Health's e-Consult pilot program will be showcased at a national Transforming Clinical Practice Initiative (TCPi) conference in August. Denver Health implemented the pilot in six specialty clinics using TCPi resources and, as a result, avoided nearly 2,500 unnecessary specialty care visits. A total of 86% of these e-consults eliminated the need for in-person follow ups, which resulted in an estimated savings of more than $2 million. Hear more from the people at Denver Health who implemented the work.
Behavioral health credentialing

Access a new resource created by the Colorado Multi-Payer Collaborative that outlines behavioral health credentialing processes. Please read these two flyers for more information.
Get tips, tools about the QPP

Get details on the final rule for year 3 released by the Centers for Medicare & Medicaid Services in the latest installment of the Colorado Quality Payment Program (QPP) Coalition's "Fast Facts in 5 Minutes." The Coalition, which was formed in 2017 to help practice teams transition to value-based payment models, releases new resources monthly. Visit the web page for updates.
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The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS). The Colorado State Innovation Model (SIM), a four-year initiative, is funded by up to $65 million from CMS. The content provided is solely the responsibility of the authors and does not necessarily represent the official views of HHS or any of its agencies.