Six health insurers are setting aside competitive differences and teaming up to make sure patients with behavioral problems don’t slip through the cracks.
A confluence of mental health issues in Colorado have plagued its residents in recent years, including a high suicide rate, an upswing in marijuana-related hospitalization, and rural barriers to care, setting the stage for the collaboration. The governor’s office has made addressing behavioral health a key priority, and Colorado just received a $65 million federal grant to build a State Innovation Model to help achieve that task.
The six payers — including Cigna, alongside smaller regional insurers like Rocky Mountain Health Plans — already had been collaborating as part of the Centers for Medicare & Medicaid Services’ Comprehensive Primary Care Initiative, which incentivizes payers to help strengthen primary care. With a similar structure to the one championed in that initiative, payers are working on their own individual blueprints to bolster ties between behavioral health and medical care, says Vatsala Pathy, director of the State Innovation Model.
“Our intent was not to create a one-size-fits-all, value-based payment reform strategy for the effort,” Pathy says, “but really to move the Colorado market further along the continuum, away from fee-for-service toward value-based payment structures in a way that supported and bolstered the integration of behavioral health and primary care, and did so in a manner that allowed the plans to both compete and collaborate with each other.”
Payers involved are now at various stages of crafting their plans. Strategies being used, Pathy says, include offering incentive payments to providers for improved care coordination, establishing a centralized phone line to help doctors link up with behavioral health specialists, or doling out minigrants for practices to hire behaviorists. The six insurers, which are also working with the state Medicaid program, hope to combine claims and clinical data from across the state to gain insights and further transform care.
Patrick Gordon, associate vice president of Rocky Mountain Health Plans, admits that it was difficult to sit around the table with competitors at first. But after the effort got underway, things clicked, and the six health insurers have been meeting frequently to chew over the complex issue. It was persuasive for payers, he says, previously seeing the success of such collaborations within the Comprehensive Primary Initiative. There, insurers found that every $1 invested in primary care translated to $5 in savings down the line.
Gordon hopes the collaboration will help inspire Colorado hospital systems to consider similar partnerships. Doing so, however, will require someone to take the lead in the state.