Innovation is the cornerstone of health care treatment, access, and delivery evolution. But it’s not limited to what some consider to be the standard definitions of breakthroughs in care and cutting-edge technology. Innovation also extends to payment reform, partnership collaborations, and solutions that pave the way for equitable and affordable access to quality care for all.
Colorado: A Catalyst for Innovation and Change
Colorado stands as a leader in health care innovation.
A Model of Integrated Care
In December 2014, the state was awarded up to $65 million from the Centers for Medicare and Medicaid Services (CMS) to implement the Colorado State Innovation Model (SIM), an approach to health care reform focused on integrating physical and behavioral health. The model’s four-pillared focus bolstered payment reform, population health, practice transformation, and health information technology efforts to meet the state’s goal of “integrating physical and behavioral health care services in coordinated community systems, with value-based payment structures, for 80% of state residents by the model’s conclusion in 2019.”
Ultimately, the Colorado SIM changed how health care is delivered and paid for in the state and propelled access to whole-person care. The model demonstrated great success across its four pillars, and learnings continue to be championed by stakeholders today.
Advancing Technology and Digital Equity
The Colorado SIM workgroup influenced the establishment of the Office of eHealth Innovation, the state entity designed to “advance health equity and reduce health disparities through coordinated health information technology, policies, and funding.” It also helped drive the development of the statewide Health IT Roadmap.
A Shift Toward Alternative Payments
Additionally, CMS announced in December 2021 that Colorado was one of four states selected to participate in an initiative to implement alternative payment models, which shift providers from volume-based to value-based payments and encourage higher quality and more equitable care. The partnership with the Health Care Payment Learning and Action Network aims to improve health care outcomes, equity, and value for everyone.
As part of the initiative, the Colorado Department of Health Care Policy and Financing (HCPF), which administers Health First Colorado (Colorado’s Medicaid Program) and the Child Health Plan Plus program, has set a goal of tying 50% of Medicaid payments to a value-based arrangement by 2025.
Driving Innovation and Collaboration for a Healthier Colorado
At Rocky Mountain Health Plans, we know change can come only with collaboration and a drive to break existing barriers. We’ve been honored to participate in state initiatives, including the Accountable Care Collaborative (ACC) and Colorado SIM, with payers, providers, and other stakeholders. In 2014, we launched a managed care payment reform and innovation program, PRIME, as a Regional Collaborative Care Organization in phase one of the ACC. The program stems from a 2012 law (HB12-1281) and helps fund behavioral health staff for contracted primary care providers. PRIME continues today and has earned statewide and national acclaim for its success — but it’s only the beginning. Now in phase two, and with phase three on the horizon, we serve as the Regional Accountable Entity (RAE) for 22 counties and continue to collectively innovate at the state and community levels to evolve care and expand access in the following ways:
- As part of the Accountable Health Communities Model, we share data-driven insights and patient population trends with providers to help inform decision-making. The data is deduced from health-related social needs screening results and data from the common health information exchange.
- Since the COVID-19 pandemic, telehealth services have become an increasingly important bridge connecting members to health care. Our partnerships with CirrusMD and Wisdo empower our members to connect with doctors and peer assistance to support their physical and behavioral health needs.
- Collaboratively investing in local initiatives, such as the innovative student loan repayment program at Colorado Mesa University, helps address mental health and social service provider shortages within Colorado communities.
- Between November 2022 and October 2023, $12.4 million in one-time investments addressed social determinants of health, increased organizational capacity, facilitated transitions of care, and supported members and enrollment organizations with the public health emergency sunset. Examples include supplementing the costs of medical services and transitions of care due to gaps in coverage as well as financing infrastructure and technology, including telehealth technology, to expand access to integrated behavioral health services.
- We design, implement, and maintain value-based payment agreements to increase funding for providers who serve RAE members with the highest needs or barriers and to sustain specific high-value services.
- Trailblazing community partnerships, such as those with Delta County Ambulance District’s Mobile Integrated Healthcare, Building Hope, and the Willow Collective, support transformative payment and funding initiatives and better serve historically underserved communities.
We’re driven by our mission to help every single person get access to the care and resources they need to flourish, and we’re proud of the impact our collaborative efforts have made. Together, we are building upon our past successes and relationships while implementing innovative approaches and partnerships to help lead Colorado into the next era of whole-person, affordable, and equitable health care.
Our core values of health equity, whole-person health, supporting counties, innovation, and rural expertise drive our every action. Learn how we’re supporting our partners, colleagues, and neighbors by honoring and advancing these values.