Minutes, Prepared by Emma Lamothe

Minutes, prepared by Emma Lamothe

In Attendance—Robert Bremer, Jessica Dunbar, Jennifer Grote, Lynn Haley, Aleah Horstman, Emma Lamothe, Lisa McCann, Bev Sloan, Shelley Solopow, Melissa Spahr

Presentation from Denver Health’sLowry Family Health Center

• Denver Health (DH)has been integrating care since 1997, when it began providing school-based behavioral health services. In 2002, a few clinics started providing part-time behavioral health until DH received a $20 million CMMI grant that allowed for behavioral health consultants (BHCs)at all of its primary care clinics. Lowry Family Health Center has been providing integrated behavioral health services for the past eight years and moved to the new building on Yosemite Street two years ago.
• Lowry is structured to provide behavioral health care as part of regular health care, so patients can see a BHC at every visit. If patients are higher risk, BHCs refer them to higher levels of care. MHCD has a direct line to DH and can make appointments within 72 hours for high-risk patients.
• Lowry staff begins each day with a 3-5 minute huddle, which includes the BH team. The BHCs identify opportunities for BH interventions, collaborate with the primary care team, and receive warm hand offs from PCPs. BHCs are available and interruptible at any time, even if they are with a patient. They mostly do curbside consults without the patient present and use a tiered referral list to track and reach out to patients, reserving actual appointments for patients who need them. For half a day each week, a psychiatrist is available. She can be reached at other times by walkie talkie.
• Lowry’s short-term model allows patients up to six sessions with a BHC. Two BHCs do 8-10 visits each day, and half of them are billable. Billable visits are scheduled and last up to 40 minutes, while non-billable visits are briefer hand offs. Same-day billing allows Lowry to bill separately for physical health and behavioral health appointments as long as they are scheduled separately within the day.
• Lowry’s patients face barriers to care and are often resistant to accepting treatment for substance abuse disorders. Finding and training staff to provide integrated care is also a challenge.

Brief about CHI’s Paper, Behavioral Health in Colorado

• In May 2015, CHI published New Models for Integrating Behavioral Health and Primary Care. The paper describes case studies of six health care providers with different levels of integration: New West Physicians (Denver), Primary Care Partners (Grand Junction), Kaiser Permanente (Front Range), Salud Family Health Centers (North Central CO), Cortez Integrated Healthcare (Western Slope), and Union Square Health Home (Lakewood).
• CHI developed five critical success factors based on their analyses:

1.Align the level of integration with patient needs and practice capacity

2. Innovate and adapt both the workforce and the workplace

3. Create new funding models that support integration

4. Recognize that patient numbers impact integration potential

5. Lead creatively and learn constantly

Items of interest from the ACC Overview Phase II Meetings

• On December 7, HCPF held a Behavioral Health Stakeholder Meeting about ACC Phase II. The meeting explained the ACC’s visionof whole-person, coordinated care with improved HIT, including eHealth and telehealth. Phase II is moving toward a blended payment method for behavioral health, rather than full capitation. Payment will be based on a fixed amount (per member per month), performance-based indicators, and the competitive pool. A single Regional Accountable Entity (RAE) will now be responsible for all duties currently performed by the RCCO and BHO. For more information about ACC Phase II, click here.
• About 200 stakeholders attended the meeting, which was not well-received. Participants expressed concerns about moving from a capitated model to a fee-for-service model. HCPF is listening to stakeholders and saying they are not going to meet their timeline for Phase II due to staffing issues.
• The JBC recently proposed a decrease in Medicaid reimbursement for primary care, citing a paper from UC that said other rate decreases did not negatively impact primary care services. The proposal has not been approved yet, so it is unclear how it will impact ACC Phase II.

• On December 8, the Colorado Medical Home Forum held a second meeting about SIM and how it aligns with ACC Phase II. Both SIM and ACC are aiming for a value-based payment system, improved HIT, and improved population health. ACC plans to provide practice support complementary to SIM support.
• Regional health connectors, practice facilitators, and clinical HIT advisors will provide SIM practice level support. UC will provide system level support by hosting two regional learning collaboratives each year. SIM representatives emphasized the need for payment reform to fund practice transformation. In the meantime, Cohort 1 practices can apply for an innovation fund to supplement the $5,000 that SIM will provide.
• Practices that did not get into Cohort 1 can get support by contacting .

Results of poll about SIM Practice Transformation Grant

• Nine clinics responded to our initial poll. Clinica Tepeyac, Denver Health (Eastside Adult, Westside Pediatrics, and Intensive Outpatient Clinic), and Rocky Mountain Youth Clinics all applied for the SIM grant and were notified that they will receive it. DH’s Level One Physicians Clinic was waitlisted.
• A lot of practicesdid not apply for the grant because it only provides $5,000 directly to clinics. Denver Indian Health & Family Services did not apply because they are a small FQHC and there was not enough benefit for them to be involved.
• UC Denver has posted a list of Practice Transformation Organizations, which includes the following Alliance members:
• Centura Health Medical Group
• Centura Health Neighborhoods
• ClinicNET
• Colorado Regional Health Information Organization (CORHIO)
• Denver Health and Hospitals
• Rocky Mountain Health Plans
• If your clinic has not responded to the poll, please contact stating whether you applied for the grant and the type of assistance for which you applied.

Next Meeting:Thursday, February 11th from 8:30am-10:00am at Colorado Access (11100 E Bethany Drive, Aurora CO 80014)

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