Moving Towards a Shared Vision of Health: Reflections on Colorado’s State Innovation Model

Ashlie Brown

August 22, 2019
Behavioral Health
Health Care Workforce
Payment Reform

“If you want to go fast, go alone. If you want to go far, go together.”

Source: No one knows

In early 2016, I kept a running tally of all the people who claimed, “I wrote Colorado’s proposal for the State Innovation Model.” When the total reached fifty, I stopped counting.

I can tell you who didn’t write the proposal: me. I was in Massachusetts at the time, leading the State Innovation Model (SIM) program there. By the time I arrived in Colorado, the proposal had been written, the award had been won, contracts had been negotiated, and the work was well underway. Hundreds of partners across the state were involved along the way.

Massachusetts and Colorado joined 32 other states, three territories, and the District of Columbia in the national State Innovation Model (SIM) initiative, funded by the Centers for Medicare & Medicaid Services (CMS). Each state-led model aims to achieve better quality of care, lower costs, and improved health for the population of the participating states or territory. The goals are the same, but the approach is unique to each state.

My experience in Massachusetts led to inevitable comparisons between the two approaches. There were a lot of similarities. Both states set out to integrate behavioral health and primary care. Both states incorporated a strong population health component, working closely with local public health and community partners to strengthen connections to clinical care. Both states struggled to accelerate the adoption of new payment model that might better support new approaches to care.

But from the beginning, I noticed one stark difference: the sheer number of stakeholders actively involved in the Colorado model easily dwarfed the Massachusetts model.

Based on my tally of proposal writers, it’s clear that a long table was set from the very beginning. If more than fifty individuals were engaged in proposal writing, it is only logical that many, many more would be pulled into implementation. And that, I would argue, has been the biggest success of Colorado SIM.

To be clear, Colorado SIM has made many measurable, programmatic gains. SIM supported 328 primary care practices and four community mental health centers in working towards integrated care — practices and centers that serve thousands of Coloradans. SIM helped to expand broadband to over 300 rural health care sites. You can find these successes and more on the SIM data hub, a collection of reports and publications detailing the outcomes of this work. Among these resources, you will find the SIM Success Stories; CHI interviewed nearly twenty key stakeholders to highlight the qualitative and quantitative gains made through this work. We have also released an in-depth look at the impact of the Colorado Regional Health Connectors (RHCs), a new workforce funded in part by SIM. You can read it here.

Colorado SIM accomplished a great deal before the program concluded on July 31, 2019. But in Colorado, SIM has always been more than a program; it has been a movement. A movement towards stronger relationships between different sectors. A movement towards collaboration instead of competition. A movement towards a shared vision for health in Colorado, and the collective capacity to do something about it.

The movement will continue in many ways, small and large. Stakeholders hope to keep the statewide momentum going through the Colorado is Ready campaign. The campaign grew out of a readiness report developed at the end of SIM and the conveners plan to maintain cross-sector communication through social media and events. You can learn more and get involved here: https://coloradoisready.org

The spirit of collaboration that pulled dozens of proposal authors together didn’t start with SIM and it won’t end with SIM either. Colorado SIM built upon a long history of working together and has set the table for even more productive partnerships in the future.

Just like the quote at the beginning of this blog, it is impossible to trace Colorado SIM back to a single source. It was written and refined by many. And that is precisely why it is powerful.

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