Implementation of Colorado’s SIM Grant Gets Underway

The implementation of the SIM grant (State Innovation Model) was initiated this month by Colorado SIM Director, Vatsala Pathy, under the Office of the Governor . Colorado received the 65 million federal cooperative agreement  to implement a health delivery system that integrates primary care and behavioral health care services.

In an interview with Policy Outreach Specialist Catherine Strode, SIM Director Pathy says SIM’s goal is to bring this integrated care model to 80 percent of the state’s population within a four-year timeline. In addition to creating systems that can offer patients integrated care, SIM will drive payment and reimbursement reform and solutions to medical workforce shortages.

Why is SIM important for Colorado?

“We’ve got some serious substance use and mental health issues in our state. We have an incredibly high suicide rate; it disproportionately affects people that are in the prime of their lives. We have significant substance use issues. It’s a big cause for emergency room visits in our state. We’ve also got some sobering substance use statistics relative to other states in the country. Communities throughout our state are facing serious and significant mental health and substance use issues.  There’s a continuum of need in terms of behavioral health from very mild to moderate issues, to severe and persistent mental illness, and there is everything in between. We believe that if we can build the right systems, and build the workforce of the future, and bring our payers to the table to pay for services differently,we can have sustainability over the long run.”

How will SIM be implemented?

“There are five pillars to SIM that we believe are all prerequisites to achieving the goal.  They include what we call ‘practice transformation’ and  ‘service delivery redesign’ which is focused on giving providers the support they need to change how they provide their careon a day-to-day basis. We believe team based care is an important ingredient. As a patient, you wouldn’t just be interacting with your physician; you may also be working with a social worker, a behavioral health professional, a nurse, and the receptionist at the front desk. Everybody’s part of that team that’s helping to make sure you get what you need.”

What kind of payment reform and reimbursement reform do you hope to achieve?

“We’re going to be working with our commercial health plan partners, as well as our public insurance providers, to explore ways in which they can help to incent value-based payment reform to support integrated care. We believe that we have some strong momentum in that direction already. We have a very significant advantage because we’ve got lots of commercial health plans in our state. Everyone has a culture of working together and collaborating and we’ve got some opportunities to leverage this work.”

What are the other areas targeted for change under the SIM grant?

“We know, especially in our rural communities, there are shortages of doctors, midlevels, behavioral health professionals.  We need to find ways to help support those providers that are already out there. If they identify that there is a need for a behavioral health professional in their clinical setting, how can we help support that? What can we do to retrain existing providers to adapt to dealing with behavioral health issues in their day-to-day practice?  The last one is focused on population health.   What can we do as communities to advance the dialogue about the many behavioral health issues that are facing our communities and how are we going to work on mitigating stigma around behavioral health and substance use issues?”

What will success look like?

“Over the course of four years, to bring integrated behavioral health and primary care in coordinated community systems with value based payment to 80 percent of our state’s population.  A majority of insured citizens in our state would be getting value-based payment reform through their insurer, that would be providing behavioral health and primary care integration. If I walk into a mental health center, and I have a physical health issue, they are able to attend to that effectively. If I go into my primary care doctor, and I’m suffering from depression, my doctor is able to refer me to a therapist in addition to putting me on some medication.  Those are going to be the markers of our success. Those are the things that we hope will happen at the end of the four years.”