Colorado’s major cities are well known leaders in high-tech healthcare. But beyond the bustling streets of Denver, Colorado Springs and Aurora, lay vast expanses of land and isolated towns that can be hundreds of miles from the nearest specialist care. Of the state’s 64 counties, only seven contain cities with populations above 100,000. The challenge of providing equal access to quality healthcare services across the rest of the primarily rural state is beyond understatement.
As a state, Colorado also has an unusually deep need for behavioral health services. Faced with one of the highest suicide rates in the country, much of the state’s rural regions lack access to quality mental health services, if any are available at all. Mental health clinics aren’t usually connected to primary care physician offices, and mental health specialists tend to have minimal interaction with hospitals until an inpatient encounter, which often occurs long after the best opportunity for productive wellness intervention.
Thanks to a $65 million grant from the Center for Medicare and Medicaid Innovation (CMMI), Colorado is solving two huge problems at once—and is one of the few states in the country to connect primary care and behavioral healthcare together in one system through telehealth technology.
Healthcare Informatics spoke with two of the project’s leaders, Healthcare IT Program Manager Ako Quammie and Barbara Martin, R.N., to learn more about the project’s four-year mission and the implementation lessons learned so far.
The four-year Colorado State Innovation Model (SIM) project began with a single idea: harness technology to connect primary care practices with mental health services at every patient encounter. In Colorado, solving the remote factor would mean using telehealth technology to bridge the service gaps, ultimately bringing needed quality services to any location.
Within its greater scope, the Colorado SIM project focuses on four sub-goals:
1. Payment reform
3. Population health
4. Health information technology
From its initial grant application, the project became a mission for both technology innovation and state reform, says Martin, who is the SIM Director and also serves as team leader for the physician practice component of the project. “The SIM was a call to action for our state to drive delivery systems and payment reform. It enabled us to come to table and say, ‘this is our vision of healthcare delivery,’” she says. “In Colorado we had tremendous leadership groups across the state and multi-stakeholder engagements that recognized that we couldn’t improve health outcomes and reduce cost of care without also thinking about the behavioral health aspect in our populations.”
Colorado’s roots in integrating primary care and behavioral health date back to 2007, far earlier than most states, Martin adds. “We want to make sure we're getting our patients activated with their physical health and their behavior health at the point when they come in for primary care, instead of waiting for them to come to a specialty mental health center.”
Charting the Course
It’s no surprise that the most popular aspect of the project has been the IT innovation, Quammie notes. But providing the connectivity and data intelligence needed to level access to healthcare services is easier said than done. Many of the physician practice groups in the state have an electronic health record (EHR) system, but didn’t always know how to utilize it to its full functionality or do high-level analytics needed for doing deep-level population health.
“For us, it's not just about interfaces. It's about working on a scale that doctors understand and see value from,” he explains. “So, let’s say you have an electronic health record, you have your staff, and then you have data that's created from that EHR. How do you manage all that? What tools and processes can be employed to ensure that the data you're putting in is accurate?”
In support of the state SIM, Quammie launched a dedicated help squad of IT professionals who go to the physician group practice sites and help staff learn more about what the data systems and network could do to advance their practices. The help team, called the Clinical Health Information Technology Advisors (CHITAs), help practices where the rubber meets the road: streamlining revenue and improving documentation for reporting. CHITA members also work one-on-one with practices to show them how to assess the reports generated by their EHRs and how to harvest that data for greater initiatives, like discovering hidden reimbursement gaps or improving high-risk patient outcomes. “When it comes to physician buy-in, it’s primarily about trust,” Quammie says. “The CHITA team is there to say, ‘well, here are some examples of patients who didn’t meet the outcome grade,’ and we can show them why, and grow together through that data learning curve.”
Getting IT Done
As the project begins its third year, the team has learned plenty about implementing such a large project without losing focus on its missions.