June 18, 2013—Primary care andbehavioral health transformation is taking SHAPE in Oregon and Colorado.
A western Colorado payment reform initiative to support integrated behavioral health in primary care settings will soon expand to Oregon. Colorado’s global payment model for primary care and behavioral health integration, known as SHAPE(Sustaining Healthcare Across integrated Primary care Efforts), is being implemented in Bend, Ore., and surrounding counties. In May, the Central Oregon Health Council, which provides governance for the region’s Care Coordination Organization, formally agreed to replicate the Colorado project.
SHAPE participants in both states will seek to rethink and re-envision the role of primary care and behavioral health as well as change how that innovative model is financially supported. The pilot includes primary care sites and payers that, on their own initiative, have taken steps toward integration that is “unfettered by fee-for-service,” said University of Colorado-Denver’s Benjamin F. Miller, PsyD, principal investigator. Miller is director of the Office of Integrated Healthcare Research and Policy at the UCD Department of Family Medicine.
“The current payment system creates disincentives for collaboration, communication and coordination among clinicians in multiple disciplines,” he said. “Treating behavioral health and physical health separately has resulted in poorer outcomes and higher costs. The body of evidence supporting integration of behavioral health in the primary care setting continues to grow.”
SHAPE is already underway in western Colorado, with reformed payments from Rocky Mountain Health Plans (RMHP). A partner in the Colorado Beacon demonstration, RMHP launched the innovative project with support from the Collaborative Family Healthcare Association (www.CFHA.net) and the University of Colorado-Denver Department of Family Medicine in late 2012. Using new global payments from RMHP, pilot practices in Grand Junction and surrounding communities are working to test the impact of fully sustainable, comprehensive primary care that includes behavioral health care.
“The integration of primary care and behavioral health through SHAPE creates financial sustainability in western Colorado and will provide a tangible, replicable, scalable model for other communities,” said Miller. “There are many behavioral health integration projects around the country. What makes SHAPE different is the payment model. It’s impossible to fix the financial sustainability problem for integration in a per-procedure, fee-for-service environment. It takes something disruptive—a global payment system that will support comprehensive primary care that has integrated behavioral health.”
Miller is leading the evaluation of SHAPE, while RMHP’s payment demonstration provides insights for a growing learning network of collaborating leaders, providers and payers.
Oregon will be the first location outside Colorado to adopt the pilot. The state has been working on care coordination and behavioral health integration, and the SHAPE model, Miller said, “is a game changer.”
“This is common sense health care,” said Jim Diegel, president and CEO of St. Charles Health System and vice chair of the Central Oregon Health Council. “Not only will patients receive more comprehensive care, but also their visits will be paid as a global payment, circumventing potential problems with lack of coverage for behavioral health. This cutting-edge approach is a great example of what can be accomplished when providers and payers collaborate.”
Both the Colorado and Oregon programs hold great promise, with payer support and opportunities for cross-pollination. Miller expects the model to expand. It only makes sense, he said. “For both the patient and the provider, global payment allows for more flexibility and comprehensive addressing of whole person health. Providers are not trapped in a workflow designed to generate volume-based payments. Instead, the payment system supports integrated, coordinated, patient-centered care.”
