Rocky Mountain Heath Plans joins in integrated health care project

Rocky Mountain Health Plans has joined in a project to test a  new effort to integrate treatment for mental illnesses and behavioral disorders with primary health care.

With funding from the Colorado Health Foundation, the Grand Junction-based health care benefits plan provider will participate in the project with the Collaborative Family Healthcare Association and University of Colorado Denver department of family medicine.

Using the RMHP payment system, up to six practices from Grand Junction and surrounding Western Colorado communities will be selected to test a global payment model for integrated behavioral health care. The project is expected to begin in the spring.

Researchers hope to gain a better understanding of the costs and other factors essential to integration and test a global payment model with primary care practices that have integrated behavioral health.

Benjamin Miller, principal investigator on the project, said research shows that treating behavioral health and physical health separately has resulted in poorer outcomes at higher costs. But for those who experience both behavioral and physical health disorders, integrated care can offer better access to needed treatment and improved outcomes, Miller said.

Part of the effort involves overcoming the stigma of mental illness and placing it in the larger context of health care, Miller said. “Behavioral health issues, such as depression, not only directly affect patients’ physical health, they also affect it indirectly, impairing adherence with and attention to their treatment plan. People don’t heal as well or as quickly. Only through integrating the mind with the body can we truly make a difference in the lives of patients.”

Primary care practices offer an obvious place for this to happen, Miller said. More patients are seen in primary care offices than in any other health care setting, and more mental health issues are dealt with in primary care than in any other context. “If we truly want to improve individual health, lower health care costs and improve the health of communities, we need to integrate mental and behavioral health into primary care.”

The existing health care system discourages primary care providers from consulting or collaborating with mental health providers, Miller added. “It is our goal to disrupt old business models in health care by showing more effective models that offer realistic, practical, on-the-ground solutions that primary care providers find valuable and rewarding to their patients. We expect replicable case examples from the pilot that will lead to long-term sustainable change in the industry.”

Patrick Gordon, program director for the Colorado Beacon Consortium, agreed. “This is not an academic exercise. This will be a transformative pilot that is being built with the goal of replicating success across the country.”

The consortium is comprised of representatives from RMHP, St. Mary’s Hospital, the Mesa County Independent Physicians’ Practice Association and Quality Health Network. The consortium is working to improve the quality and efficiency of health care services starting in a seven-county region of Western Colorado that includes Mesa County.

The project won’t simply tweak the status quo, Gordon said. “Since it’s impossible to fix the problem on a per-procedure, fee-for-service basis, we are starting with fundamental redesign of the payment system. We will implement value-based, non-fee-for-service payments that support the integration of behavioral and primary care and provide better support for behavior changes that are critical to improved health outcomes.”

This approach fundamentally changes the structure of how behavioral health is handled rather than offer a short-term fix, Gordon added. “Starting on a small scale, building as we go and leveraging the power of partnership, we are going to turn the current model on its head.”