In my nearly six years as a State Representative, I’ve spent more time and energy on healthcare reform than on any other topic. I’ve sponsored legislation to improve regulations of free-standing emergency rooms, require cost transparency from hospitals, implement a reinsurance program (which has saved consumers more than 20% on premiums in the individual market), and establish a board to set upper payment limits on prescription drugs.
I’ve also proudly supported the work of my colleagues on preventing surprise out-of-network bills, capping the price of insulin, establishing a standardized health insurance option, and more.
Though these efforts have done much to save people money and improve health outcomes, they all treat symptoms rather than curing the disease, which is that our healthcare system incentivizes a higher volume of services rather than a higher value of care.
I’m not the first person to notice this problem. From 2015-2019, Colorado’s State Innovation Model (SIM) utilized federal grant funding to advance value-based payment structures and support 344 primary care practices and four Community Mental Health Centers in integrating behavioral and physical health care.
The Hospital Transformation Program (SB17-267) and the Primary Care Payment Reform Collaborative (HB19-1233) have also meaningfully advanced conversations about paying for value over volume.
Last Spring, after the passage of the federal American Rescue Plan Act (ARPA), House Speaker Alec Garnett encouraged my colleagues and me to think big about how we can use these one-time federal resources to meaningfully transform systems. Many of my colleagues are doing incredible work to transform behavioral health, housing, workforce development, and economic support programs in Colorado.
For me, it kept coming back to value and integration in healthcare. I remember lying awake in bed one night, my mind racing through possibilities, when I decided to get up sometime after midnight and write an initial proposal for what I called “SIM 2.0.”
I know I’m not the only person to have thought of this idea or moniker, but my proposal included a new grant program to help primary care practices integrate behavioral health services and move toward value-based payments. The theory was that the grants and technical assistance could help practices upgrade technology and change workflows, and that the improved payment models would sustain the practices over the long term as care delivery became more efficient, health outcomes improved, and downstream costs caused by untreated conditions were avoided.
That idea is now the core of House Bill 22-1302, which appropriates $32M of ARPA funds to primary care practice transformation grants and technical assistance programs.
As these ideas were developing, I began work on addressing another component of this problem–the conflicting requirements of health insurance plans. You see, many health insurance carriers have made progress on incorporating value-based payments–also commonly called alternative payment models, or APMs–into their contracts with primary care providers. But they all do it their own way, which leaves the average doctor’s office dealing with a different set of quality metrics and payment parameters for every insurance company. Can you imagine a doctor having to identify their patient’s insurance company before they could know which health outcomes would determine how they get paid? It makes no sense.
That’s why I’m sponsoring House Bill 22-1325 with Representative Yadira Caraveo, a pediatrician who shares my commitment to transforming our healthcare system. The bill will require alignment between insurance carriers of certain APM parameters to reduce administrative cost and simplify the work of primary care providers so they can spend less time dealing with insurance companies and more time focusing on their patients.
I truly believe these are the most significant things we can do in Colorado to improve equity, outcomes, and value in our healthcare system.
Together, these efforts build the foundation of a universal primary care system in Colorado that will provide more efficient, whole-person care that will make people healthier and save them money by reducing the need for expensive hospital care and prescription drugs.
These are the kinds of transformations that go beyond treating symptoms of a broken system to actually start curing the disease.
Read more at ColoradoSun.com