SHAPE Implemented In Oregon

A western Colorado Payment reform initiative supporting integrated behavioral health in primary care settings will soon expand to Oregon. Colorado’s global payment model for primary care and behavioral health integration “Sustaining Healthcare Across Integrated Primary Care Efforts” or SHAPE, is being implemented in Bend, Oregon and surrounding counties.

In May, the Central Oregon Health Council which provides governance for the region’s Care Coordination Organization, formally agreed to replicate the Colorado project.

SHAPE participants in both states will begin to rethink and re-envision the role of primary care and behavioral health as well as change how the innovative model is financially supported. “The pilot includes primary care sites and payers that have taken steps toward integration that is unfettered by fee-for-service”, said University of Colorado-Denver’s Principal Investigator Benjamin F. Miller, PsyD. Miller is Director of the Office of Integrated Healthcare Research and Policy at the UCD Department of Family Medicine.

According to Miller, “The current payment system creates disincentives for collaboration, communication, and coordination among clinicians in multiple disciplines. Treating behavioral health and physical health separately has resulted in poorer outcomes and higher costs. The body of evidence supporting integration of behavioral health in the primary care setting continues to grow”.

Miller also reports that integration of primary care and behavioral health through SHAPE creates financial sustainability in western Colorado and provides a tangible, replicable, scalable model for other communities. There are many behavioral health integration projects around the country” As he explained, “What makes SHAPE different is the payment model.”

As he continued to say, “It’s impossible to fix the financial sustainability problem for integration in a per-procedure, fee-for-service environment. It takes something disruptive such as a global payment system to support comprehensive primary care with integrated behavioral health.”

SHAPE is already underway with reformed payments from Rocky Mountain Health Plans (RMHP). As partner in the Colorado Beacon demonstration, RMHP launched the innovative project with support from the Collaborative Family Healthcare Association and the University of Colorado-Denver Department of Family Medicine in late 2012.

Using new global payments from RMHP, pilot practices in Grand Junction and surrounding communities are working to test the impact of fully sustainable comprehensive primary care that includes behavioral healthcare. Miller is leading the evaluation of SHAPE, while RMHP’s payment demonstration provides insights for a growing learning network of collaborating leaders, providers, and payers.

“This is common sense healthcare,” said Jim Diegel, President and CEO of St. Charles Health System and Vice Chair of the Central Oregon Health Council. “Not only will patients receive more comprehensive care, but their visits will be paid as a global payment circumventing potential problems with lack of coverage for behavioral health.”

Both the Colorado and Oregon programs hold great promise with payer support and opportunities for cross-pollination. The model is expected to expand since according to Miller, “Global payments allow for more flexibility and comprehensively address whole person health. Using this model, providers will not be trapped in a workflow designed to generate volume-based payments. Instead, the payment system would support integrated, coordinated, patient-centered care.”

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