GRAND JUNCTION, CO - Healthcare leaders in the city of more than 58,000, which is known as being a center of healthcare innovation, are once again demonstrating their initiative via a partnership aimed at making an integrated payment model for behavioral health and primary care financially viable.
Collaborating on the project are the Colorado Beacon Community, Rocky Mountain Health Plans, the Colorado Health Foundation, the University of Colorado Denver and the New York-based Collaborative Family Healthcare Association.
The integration of primary care and behavioral health is nothing new, noted Benjamin Miller, PsyD, board president the Collaborative Family Healthcare Association and an assistant professor and the director of the Office of Integrated Healthcare Research and Policy at the University of Colorado Denver. However, organizations that integrate the two care models often find themselves unable to sustain themselves financially over time.
"Part of the reason we have that problem," Miller said, "is that you have two pots of money to take care of healthcare. You've got a mental health pot of money and you've got a physical health pot of money. When you talk about integration you have to integrate at multiple levels to make it successful. One of those levels is financial."
Figuring out how to make the financial side of the behavioral health equation mesh within an integrated health system that pays for overall health and well-being of the member is gaining steam, especially in light of the understanding that mental health issues often interfere with adherence to treatment and medication regimens for the treatment of a physical condition.
This is especially true among the dual eligible population, those old enough to qualify for Medicare and poor enough to also qualify for Medicaid.
One example of the need to manage both physical and mental health is seen in the June partnership between Massachusetts Behavioral Health Partnership and Blue Cross Blue Shield of Massachusetts, which aims via a three-year demonstration project to integrate all aspects of care for dual eligibles.
"Integrating all forms of care - medical, behavioral, dental, vision, personal care - will be a vital part of serving members in this program," noted Andrew Dreyfus, president and CEO BCBSMA in a prepared statement.
In Grand Junction, in order to address the financial conundrum that has bedeviled so many organizations, the partners are launching their own three-year, multi-site pilot. They will select up to six practices from Grand Junction and the surrounding area that have already integrated primary care and behavioral health, said Patrick Gordon, Colorado Beacon Consortium's program director and director of government programs at Rocky Mountain Health Plans.
In the "actuarial exercise" of the pilot, Rocky Mountain will use a model that revalues the impact of intervention on trends at the micro-level. The model will calculate a projected impact on the total spend then will make conservative bets about what the value of the interventions are going to be. Everyone involved in the pilot will try to hit targets that are transparent to all participants.
"... (E)ssentially what we're doing is accountable care with multiple parties and a community governance structure," Gordon said. "The difference is that most people talk about accountable care, they say A-C-O - accountable care organization. ... For us to be successful we got to drop the 'O' off the end of that because when you limit to one organization, even if you achieve a great deal of integration, it's still limited in space and time."
Gordon and Miller say the primary care-behavioral health pilot is much more than just trying to solve a financial problem. Their ultimate goal is to create a solution that is replicable across the country and that will change the "rules" of healthcare.
"We are literally in this to change the game," Miller said, who is the project's principal investigator. "This literally goes to the heart of healthcare. We believe that by doing this - by integrating care and by figuring out the financial barriers to integrating care - we cannot only help achieve the 'Triple Aim' but we can also change the way that our community is actually expecting care and that's something totally different."
Senior Editor, Chris Anderson also contributed to this report.