January-February 2017 by Colorado Medical Society

January/February 2017

Volume 114, Number 1

COLORADOâ&#x20AC;&#x2122;S HEALTH INNOVATION ECOSYSTEM FORWARD-THINKING INDIVIDUALS COMING TOGETHER TO IMPROVE HEALTH CARE

Award-winning publication of the Colorado Medical Society

contents Jan/Feb 2017, Volume 114, Number 1

Features. . . 13

Incubating good ideas–10.10.10, a venture generator,

Advancing technology– Colorado’s Office of eHealth Innovation is advancing the effective use of HIT and health data to improve quality, access, costs and care.

Health care innovation–StartUp Health Colorado is an innovation hub that supports health entrepreneurs, “doctorpreneurs,” investors and industry stakeholders.

Legislative preview–In the 2017 General Assembly, CMS is committed to health plan reform to spur competition and transparency in the marketplace and encourage innovation.

State budget considerations– Budget pressures challenge Colorado elected officials as they balance required expenditures and new programs and initiatives.

United-Rocky merger–CMS urges the DOI to strengthen the proposed agreement between UnitedHealth Group and RMHP to maintain and grow RMHP’s successes.

Colorado working together–Within a diverse working group and through our own relationships with the congressional delegation, CMS is making recommendations on federal health care reform.

Your opinion matters–AMA explores CMS’s method of surveying physician members to form policy and make the case for reforms in the health care system.

5 President’s Letter 7 Executive Office Update 33 In Memoriam: Richert E. Quinn Jr., MD 35 COPIC Comment 36 Reflections

Leveraging strengths–SIM's aim to integrate behavioral health and primary care is spurring positive outcomes for patients.

Physician Leadership Skills Series– CMS has set the topics for PLSS that will help CMS members develop and deepen crucial skills for tomorrow’s health care.

Departments

Final Word–Mike Biselli, president of Catalyst Health-Tech

Cover story The practice of medi-

cine is changing. Forward-thinking Colorado companies are using innovation to drive down costs, improve quality, and improve the care experience for both patients and practices. Prime Health, featured in the cover story starting on page 8, has created an ecosystem of Colorado entrepreneurs and investors to accelerate good ideas that will flex the rigid health care system and influence positive change. Throughout this issue see examples of how improving health care can start with an individual, take root through partnerships, and spread through strategic action and collaboration.

Inside CMS

38 40

Medical News Classified Advertising

Colorado Medicine for January/February 2017

supports serial entrepreneurs as they explore and solve “wicked” problems in health care.

Innovation, talks about his work with health-tech startups to digitalize the health care system and turn regional ecosystems into enduring sites of transformation.

C OLOR A D O M EDICA L S O CI ET Y 7351 Lowry Boulevard, Suite 110 • Denver, Colorado 80230-6902 (720) 859-1001 • (800) 654-5653 • fax (720) 859-7509 • www.cms.org

OFFICERS, BOARD MEMBERS, AMA DELEGATES, and STAFF

2017 Officers Katie Lozano, MD, FACR President M. Robert Yakely, MD President-elect Michael Volz, MD

Treasurer

Alfred D. Gilchrist Chief Executive Officer

Board of Directors Sami Diab, MD Curtis Hagedorn, MD Mark B. Johnson, MD Richard Lamb, MD David Markenson, MD Halea Meese, MSS Gina Martin, MD Patrick Pevoto, MD, RPh, MBA Charlie Tharp, MD Kim Warner, MD C. Rocky White, MD Kelley D Wear, MD

AMA Delegates A. “Lee” Morgan, MD M. Ray Painter Jr., MD Lynn Parry, MD Brigitta J. Robinson, MD AMA Alternate Delegates David Downs, MD Jan Kief, MD Katie Lozano, MD Tamaan Osbourne-Roberts, MD AMA Past President Jeremy Lazarus, MD

Michael Volz, MD Immediate Past President COLORADO MEDICAL SOCIETY STAFF Executive Office Alfred Gilchrist, Chief Executive Officer, Alfred_Gilchrist@cms.org Dean Holzkamp, Chief Operating Officer, Dean_Holzkamp@cms.org Dianna Mellott-Yost, Director, Professional Services, Dianna_Mellott-Yost@cms.org Tom Wilson, Manager, Accounting, Tom_Wilson@cms.org Division of Communications and Member Benefits Kate Alfano, Communications Coordinator, Kate_Alfano@cms.org Mike Campo, Director, Business Development & Member Benefits, Mike_Campo@cms.org Division of Health Care Policy Chet Seward, Senior Director, Chet_Seward@cms.org JoAnne Wojak, Director, Continuing Medical Education, JoAnne_Wojak@cms.org

Division of Health Care Financing Marilyn Rissmiller, Senior Director, Marilyn_Rissmiller@cms.org Division of Information Technology/Membership Tim Roberts, Senior Director, Tim_Roberts@cms.org Tim Yanetta, Coordinator, Tim_Yanetta@cms.org Division of Government Relations Susan Koontz, JD, General Counsel, Senior Director, Susan_Koontz@cms.org Adrienne Abatemarco, Program Manager Adrienne_Abatemarco@cms.org Colorado Medical Society Foundation Colorado Medical Society Education Foundation Mike Campo, Staff Support, Mike_Campo@cms.org

COLORADO MEDICINE (ISSN-0199-7343) is published bimonthly as the official journal of the Colorado Medical Society, 7351 Lowry Boulevard, Suite 110, Denver, CO 80230-6902. Telephone (720) 859-1001 Outside Denver area, call 1-800-654-5653. Periodicals postage paid at Denver, Colorado, and at additional mailing offices. POSTMASTER, send address changes to COLORADO MEDICINE, P. O. Box 17550, Denver, CO 80217-0550. Address all correspondence relating to subscriptions, advertising or address changes, manuscripts, organizational and other news items regarding the editorial content to the editorial and business office. Subscriptions are available for $36 per year, paid in advance. COLORADO MEDICINE magazine is the official journal of the Colorado Medical Society, and as such is also authorized to carry general advertising. COLORADO MEDICINE is copyrighted 2006 by the Colorado Medical Society. All material subject to this copyright appearing in COLORADO MEDICINE may be photocopied for the non-commercial purpose of education and scientific advancement. Publication of any advertisement in COLORADO MEDICINE does not imply an endorsement or sponsorship by the Colorado Medical Society of the product or service advertised. Published articles represent the opinions of the authors and do not necessarily reflect the official policy of the Colorado Medical Society unless clearly specified. Alfred D. Gilchrist, Executive Editor; Dean Holzkamp, Managing Editor; Kate Alfano, Assistant Editor; Chet Seward, Assistant Editor. Printed by Hampden Press, Aurora, Colorado

Inside CMS

president’s letter Katie Lozano, MD, FACR President, Colorado Medical Society

Advocating for health insurance coverage that works A range of salient health insurance policy debates will likely occur in the 2017 Colorado General Assembly and 115th U.S. Congress due to macro-economic and political influences including the presidential election outcome, the prospective political backlash from anticipated double-digit increases in health insurance premiums in the individual market, the political engagement of the health plans being litigated by the U.S. Department of Justice, the budget pressures generated by a growing Medicaid-eligible population and backlash from a perceived “crowd-out” of other infrastructure funding needs, and unresolved network adequacy and access issues from 2016 Division of Insurance (DOI) rulemaking. The legislative and executive branches of state government are two years into a debate over policy solutions to address the consequences of narrow networks. Narrow networks in highly concentrated insurance markets create a powerful and unfair advantage over providers. A good-faith mediation last summer between the Colorado Association of Health Plans (CAHP) and CMS failed when a few insurance companies insisted that CAHP discontinue discussions. The DOI recently finalized a series of rulemakings on some but not all network adequacy issues, such as finding a consensus on surprise medical bills and excess charges. Resolution of inequities in the current multi-payer system is critical so interactions between providers and insurance companies can turn to a focus on value rather than market share and volume. As approved in the 2017 CMS work plan, your medical society will take full

advantage of the post-election public policy environment to aggressively advocate for incremental changes in the multi-payer system, both public and commercial and at the state and national level. We aim to reduce barriers to cost-effective, quality care and increase your professional satisfaction. To achieve this, CMS will: • Continue efforts to block the megamergers of Anthem-Cigna and Aetna-Humana, • Ensure a successful transition to the Medicare Quality Payment Program (QPP) by Colorado physicians, • Advocate for enhanced patient and provider protections for network adequacy of health insurance plans through the DOI’s Physician Advisory Group, including a pilot project that allows DOI to act on a pattern of provider complaints against insurance companies for unfair practices. • Authorize the Council on Legislation to cause legislation to be filed to protect consumers from surprise outof-network (OON) charges not covered when care is provided in an innetwork facility, create appeal rights for providers when they are being de-selected without cause from insurance products, and address other network adequacy and access reforms consistent with CMS policies. • Influence how health care systems reduce cost and improve quality by proactively engaging with the state’s Commission on Affordable Health Care. • Optimize the Accountable Care Collaborative (ACC) program as a quality, Colorado community-focused alternative to national Medicaid managed care plans.

Colorado Medicine for January/February 2017

• Improve care quality and access for injured workers in Colorado. • Participate in United’s acquisition of Rocky Mountain Health Plans to ensure a fair and transparent transition and to preserve and expand RMHP’s culture of collaboration with physicians, and • Shape the federal conversation about the future of health care in America by participating in a Colorado-based federal coalition, working in concert with the American Medical Association and leveraging our own relationships with federal legislators. The Colorado Medical Society has a long history of supporting health insurance coverage for all Coloradans. This is not a new debate and we are experienced in approaching the issue with a focus on physicians and our patients. We also understand that we are only one advocacy organization in a complicated network of interests and no reform proposal will satisfy all of our goals for fair coverage. Navigating this realm requires agility and flexibility by the Colorado Medical Society, which is fortunately supported by the new CMS governance model and Central Line virtual engagement platform. I look forward to working with all of you this year and gaining your insight and perspective. n

Plug in to your reinvented medical society. Log on today: www.cms.org/central-line 5

Colorado Medicine for January/February 2017

Inside CMS

executive office update Alfred Gilchrist, CEO Colorado Medical Society

The Rocky-United deal: Rock on! UnitedHealth Group’s proposed acquisition of the venerable Rocky Mountain Health Plans, currently pending before state regulators, is unlike any in our previous experience. The level of transparency and cooperation by both Rocky and United has been unprecedented in contrast to our involvement with other acquisitions. Given the controversy and potential impacts of consolidation, this level of conduct should set the standard for insurance industry mergers and acquisitions across the country. As industry consolidation increases along with enhanced market share and power, policymakers need to address the gaps between stakeholder involvement and final decision-making by regulators, but that is a different topic for a future column.

way: “Health care in western Colorado was shaped in large measure by the nonprofit nature of RMHP as the dominant carrier and provider partner, and we want our valued working relationship to continue uninterrupted.”

Rather than United, Rocky is way out front in the community promoting the benefits of the acquisition, not the least of which is the vital component that Rocky’s brand and mission, along with the current management team and corporate headquarters in Grand Junction, will remain intact. This is a big deal on the Western Slope for a variety of reasons. A Montrose physician put it this

These positive dynamics – transparency and collegial interaction, Rocky’s belief in the benefits of the acquisition and input from our Western Slope members – created a dialogue that helped us better understand the legal aspects of the agreement, the concerns and aspirations of our Western Slope members. We also got a sense for United’s motives, two of which hold promise and, not sur-

As is the case with any merger or acquisition that could impact our members, we stepped in to take a closer look. We examined the acquisition for its real-world impact on physicians and patients, with the specific goal of determining opportunities to enhance the agreement and expand collaboration with the merged companies if approved by state regulators. This decision resulted in numerous in-person Western Slope listening sessions with physicians and additional conversations with the two companies.

prisingly, are based on Rocky’s approach and style. The first involves Medicaid, a large and growing payer in Colorado. United has a significant Medicaid line of business and views Rocky’s Medicaid innovations, including payment reforms, as a laboratory for improvement in their system. The second is a vision from United’s CEO that United will study and learn Rocky’s way of doing business with physicians and apply what they learn to other parts of the country. Well over 40 years ago, slightly before the time I started in the business of physician advocacy, a small group of dedicated practicing physicians in Grand Junction had a vision to build a health plan with a culture to work with them as partners. Since that time, Rocky has earned a national reputation and recognition for outstanding achievements as a community-based health plan. Should that pioneering spirit and collaborative vision from some 40 years back take hold in United, Grand Junction will be back in the spotlight and we’ll be saluting their achievement once again. n

All friends of medicine are eligible to participate. Email susan_koontz@cms.org or call 720-858-6327 or 800-654-5653, ext. 6327 Colorado Medicine for January/February 2017

COLORADOâ&#x20AC;&#x2122;S HEALTH INNOVATION ECOSYSTEM FORWARD-THINKING INDIVIDUALS COMING TOGETHER TO IMPROVE HEALTH CARE

Colorado Medicine for January/February 2017

Cover Story In 2012, the Institute of Medicine at the National Academy of Sciences recommended the adoption of new efficiency measures and information technology, claiming that a combination of the two could reduce health care spending by up to a third. As a means of assessing the new ideas, processes and technologies that promised to reduce spending, many looked to the Triple Aim, a concept that stated innovations should increase patient satisfaction, improve outcomes and cut costs. It became a rally cry for innovators, and the first ray of hope for those who feared spending might never be brought under control. Jeffrey Nathanson, CEO, Prime Health Editor’s note: The practice of medicine is changing. Forward-thinking Colorado companies are using innovation to drive down costs, improve quality, and improve the care experience for both patients and practices. These leaders have created an ecosystem of Colorado entrepreneurs and investors to accelerate and foster good ideas that will flex the health care system and influence positive change. In many examples throughout this issue, improving health care starts with an individual, takes root through partnerships, and spreads through strategic action and collaboration. The Colorado Medical Society and American Medical Association are playing our part, too, working on behalf of and in collaboration with physicians to lead change and move health care forward in the exam room, boardroom and the public policy realm. Share your feedback at enews_editor@cms.org. The U.S. health care system is broken. We have higher costs and worse outcomes than most of the world’s industrialized nations. In 2016, health care spending exceeded $3.5 trillion, accounting for 17.8 percent of our GDP and surpassing $10,000 per person. Though cost increases slowed under the Affordable Care Act (ACA), coming in at 5.8 percent in 2016 and down from the pre-recession rate of 8 percent, health care spending is still growing at an unsustainable pace. If allowed to continue, the consequences for our country could be grave.

Yet health care as an industry has traditionally been slow to adopt innovation, with some experts estimating a 17-year lag before new technologies make it to clinical practice. Adding to this delay, one of the first large-scale attempts to transform health care through digital technology, the electronic health record (EHR), was a famous disappointment. Instead of improving the delivery of care – as it was intended to do – the EHR significantly increased the administrative burden on physicians, while significantly decreasing their levels of professional satisfaction. With the EHR, physicians frequently found themselves trapped behind computer screens, clicking and typing away, instead of interacting with patients. Needless to say, the early failings of the EHR left providers of all kinds wary of innovation, precisely at a time when we could least afford it. Provider-friendly innovations To offset the widespread physician burnout caused by clunky EHRs, innovators amended the Triple Aim. Alongside reduced costs, improved outcomes and patient satisfaction, they added provider satisfaction. This represented a seminal moment in health innovation. New ideas, processes, and technologies would, from this point forward, be designed to fit into the provider workflow in a seamless manner. Those that did not would be deemed failures.

refined sense of both the clinical setting and day-to-day operations within it, which was something innovators often lacked. Suddenly, the prospect of launching the next great health care company and disrupting the industry overnight became a distant prospect, and health-tech innovators of all kinds experienced a dawning realization. To reimagine our industry, they would have

“The profound shift in health innovation ... accelerated the development of regional communities ... to reimagine health care. Known as health innovation ecosystems, these communities of innovators frequently collaborated to ensure that new ideas, technologies and processes were properly researched, funded and vetted.” to work alongside the members of the existing health care system, closely collaborating with the executives, administrators and clinicians whose jobs they hoped to transform. Across the country – and, perhaps, even the world – the profound shift in health innovation brought about by the newly codified Quadruple Aim accelerated the development of regional communities of physicians, investors, technologists, academics and policymakers who were already working together to reimagine health care. Known as health innovation ecosystems, these communities of innovators frequently collaborated to ensure that new ideas, technologies

But seamless innovation required insight into the provider’s experience, a

Colorado Medicine for January/February 2017

Cover story (cont.)

Three Prime Health portfolio companies Examples of innovators, in their own words Prima-Temp | www.prima-temp.com

Prima-Temp has revolutionized wireless, continuous temperature sensing. Our devices and software precisely and continuously measure core body temperature. Our first product, OvuRing, passively and continuously tracks a woman’s core body temperature, detecting the subtle changes that occur before ovulation, then sends an alert to her phone when she’s most fertile.

Radish Systems | www.RadishSystems.com

Radish Systems improves how health care organizations communicate with phone callers by adding visual information – care plans, photos, directories, test results – to voice/text calls. ChoiceView®, the award winning, HIPAAcompliant, multi-channel platform bridges telephone and Internet worlds to support many voice and data use cases. As is often said, “One picture is worth a thousand words.” Radish’s patented mobile enterprise software platform allows health care firms (providers, payers, etc.) to seamlessly exchange visuals during voice/text calls. Health care firms struggle to cost-effectively communicate to improve their callers’ care and health. Callers increasingly use mobile phones and the Internet; more than 85 percent of adults in the United States already own smart devices. Health-related calls often involve complex information with potential consequences for misunderstandings or non-compliance. Callers are upset with long waits and frustrated by automated systems. Callers are aging, sometimes hard of hearing, and using many different languages. If callers don’t understand or receive clear answers to critical questions, the results could be problematic. Undesirable results include lack of adherence to medications, hospital readmissions, more office and ER visits, or worse. ChoiceView allows health care firms to talk/chat with callers (patients, caregivers, other HC providers) using any phone while instantly sharing visual content via smartphones or browsers (PCs, Macs, tablets). ChoiceView delivers improved population health, improved patient experience/care, and reduced per-capita costs.

RxAssurance | www.rxassurance.com

Our platform, which addresses the American Opioid Epidemic and other chronic disease states, just launched last fall and is receiving great traction. OpiSafe represents a single prescriber dashboard with four verified data streams for opioid prescribers (ePROs, PDMP, EHR, & Lab results) – a huge innovation for a sector of health care that is in crisis. Our lab program allows laboratories to upload lab results into our OpiSafe platform, thus providing medical professionals access to all relevant opiate-prescribing patient data in one place. OpiSafe is a very sophisticated, value-add delivery portal for the labs that they pay for on a per-report basis. Our sales pipeline includes several large pain clinics, large health care organizations, several strategic specialty lab partners that are using OpiSafe as their provider portal, insurance companies and PhRMA companies that are considering using our platform to complement their product offerings.

and processes were properly researched, funded and vetted. More often than not, they focused on entrepreneur-driven innovations, since entrepreneurs, more than anyone else, seemed to be the professionals most qualified to bring innovations to market. Colorado’s health innovation ecosystem In Colorado, our regional health innovation ecosystem has a name: Prime Health. It began in 2012 as a meet-up, a monthly gathering of health innovators from around Colorado, held in co-working spaces and tech incubators in Denver, Boulder and Fort Collins. Founded by Denver South Economic Development, it quickly attracted major sponsors like Kaiser Permanente, Aetna, iTriage, and Ernst and Young. When it became a standalone nonprofit in 2015, it received funding from Rose Community Foundation and the Colorado Health Foundation. Prime Health grew quickly for two reasons. The first was the people. Our members include more than 2,500 health care administrators, physicians, entrepreneurs, investors, technologists, policymakers and academics. These are highly educated, highly intelligent, highly experienced professionals who are intent on improving the delivery of care through innovation. To ignore them would be a mistake, and the major organizations that have partnered with us recognize this. The second reason for Prime Health’s rapid launch was the structure of our ecosystem. To further encourage collaborations between the members of our community, Prime Health regularly convenes them at monthly meet-ups in cities along the Front Range. To ensure that new products and services meet the Quadruple Aim, each year we enlist dozens of health care experts to vet startups in a three-month-long process known as Prime Health Qualify. The half-dozen or so companies identified by this process as ready for adoption within the health care system are then given the chance to pitch their intentions at

Colorado Medicine for January/February 2017

Cover story (cont.) the Prime Health Challenge, a major public event where payers and providers are able to select the innovations they would like to pilot. In a few short years, Prime Health has qualified dozens of new products and services. We’ve helped more than 30 entrepreneurs secure pilots with major health care organizations. Those startups that have participated in the challenge have collectively gone on to raise more than $34 million. And we’re just getting started. Joining the movement Innovation can be messy, especially when it’s driven by entrepreneurs. Yet we’ve found that the messiness of company formation, expansion and even collapse all serve to enhance the dynamism, robustness and maturity of our ecosystem. Startups grow, attracting employees. Employees leave, joining other companies or founding startups of their own. Just in the past few years, Colorado-based digital health companies like Trizetto, Healthgrades and iTriage have inspired the development

of a number of health-tech startups, including DispatchHealth, ListenMD and MDValuate. Importantly, although our ecosystem is constantly changing, the ideas, processes and technologies being developed within it are consistently becoming more sophisticated, more refined and more targeted. Prime Health wants to grow Colorado’s health innovation ecosystem. Fortunately, we have several advantages working in our favor. Colorado has a booming startup community. It has the nation’s second most educated population and its top labor supply. Forbes recently named it the best place to do business in the country, and Business Insider called it the fastest growing state economy. All of these factors work together to ensure that a steady stream of talented innovators flows into our ecosystem – innovators who are willing to develop technology after technology, build startup after startup, and commercialize innovation after innovation in their quest to improve the affordability, efficiency and accessibility of the U.S. health care system.

But the most important asset we have is our community. Our ecosystem is the powerhouse of innovation that it is today because of the participation of health care organizations like Kaiser Permanente, Aetna and CU Anschutz; innovation economy institutions like Catalyst HTI, Innosphere and Innovation Pavilion; health-tech startups like RxAssurance, Prima-Temp and Radish Systems; and, most importantly, individuals like you. If you’re not currently a member, please come to our monthly meet-ups. Join our online collaborative platform, Prime Health Collaborate. Attend our quarterly summits and annual challenges. Together, we’ll make sure that health innovations reduce costs, improve outcomes, and increase satisfaction for patients and providers alike. n

Jeffrey Nathanson is the CEO of Prime Health. He is also the president of 10.10.10, a new impact venture generator and innovation program focused on solving “Wicked Problems” with serial entrepreneurs.

Colorado Medicine for January/February 2017

Features

Incubating good ideas New venture generation, innovation and collaboration in a post-accelerator world also provide access to qualified mentors and investors and help with customer discovery and pitch development. Startups and accelerators have become a big business. TechStars, a Boulderbased accelerator, has expanded to cities throughout the U.S. and around the world; 13 Y Combinator startups have been valued at more than $50 billion; and by 2016 more than 650 accelerators were in operation around the world. Tom Higley, Founder and CEO, 10.10.10 Health care is a complex, adaptive system. Its interconnected elements are dynamic and resilient. Larger organizations within this system possess something like the human immune system that identifies and eliminates existing and potential internal threats. While this is usually a good thing, a targeted “threat” may be something the system needs, and by overreacting, the system destroys internal innovation that could have given new life and health to the organization. Startups, new ventures created by a founder or group of co-founders, exist to give effect to change, to bring that change to life and make it sustainable. Startups seek to become dominant in their respective markets. They do not yet have an internal immune system. Many startups are supported by “accelerators,” programs 13 weeks in length (give or take) that focus exclusively on what happens after a startup is created. Accelerators help a startup hone its elevator pitch and value proposition. They

Unlike accelerators, venture generators provide support to serial entrepreneurs – sometimes called “Prospective CEOs” – before these entrepreneurs create their next new venture. For example, before they even have an idea for their next venture, Prospective CEOs are invited to participate in 10.10.10 Health, a program that pitches 10 “wicked” problems in health that could be turned into sizeable market opportunities: 10 successful entrepreneurs from throughout the United States spend 10 days together exploring 10 wicked problems in health. During their first day together, problem advocates pitch problems like Alzheimer’s, antibiotic resistance, patient data matching, childhood obesity, and pandemics and bioterrorism. After five days exploring the problems, the Prospective CEOs lead teams in a five-day “sprint” designed to solve big problems and test new ideas. Within 60 days of the first 10.10.10 Health program the first startup, BurstIQ, was formed and funded. One of the other Prospective CEOs from 2015 co-founded Airstream Health. And the first company to emerge from the

Colorado Medicine for January/February 2017

10.10.10 Health 2016 program, Concert Health, was formed in September. As its programs improve, 10.10.10 expects half of its 10 Prospective CEOs will create new ventures offering new, market-based solutions to wicked problems in health. Validators A key aspect of the 10.10.10 program is the relationship it facilitates between the Prospective CEOs and individuals and organizations known as “Validators.” Validators come to the program with deep domain experience. They provide subject matter experts to help entrepreneurs understand why a problem is important, why certain solutions to a problem may work, and why others may not work as expected or find acceptance in the marketplace. Because the Prospective CEOs and Validators come from very different worlds and cultures – with a different vocabulary, dress code and perspective – they almost never connect in the real world. They move in entirely different spheres of influence. Yet they have much to offer one another. Two cultures, two types of innovation In larger organizations that provide 10.10.10 with its Validators, innovation is a frequent topic of conversation. Clayton Christensen’s pioneering book, Innovator’s Dilemma: When New Technologies Cause Great Firms to Fail, introduced a distinction between sustaining innovation and disruptive innovation that continues to dominate the discourse today. Larger companies prefer sustaining innovation (for reasons we will explore).

10.10.10 (cont.) When established companies talk about and commit resources to innovation, they almost always mean sustaining innovation. Sustaining innovation starts with identifying needs of current customers in an existing market. It applies proven technologies to well-known markets and products with the expectation that the resulting product or service will offer current customers something that is better, faster or cheaper.

disruptive innovation. Innovation is to entrepreneurs what water is to fish – the medium in which they live and breathe. (Ironically, this means entrepreneurs devote as much time thinking and talking about innovation as fish spend thinking about and discussing water.) The example below is from a recent conversation with a successful serial entrepreneur who has founded two large health care companies and served as CEO:

Entrepreneurs more frequently practice

“I worked at a large company where

all we talked about was innovation – the need for it, how to do it, why it mattered. The thing is, we never did it. We never innovated. Yet in my startups as part of a team, we never talked about innovation. But that’s all we ever do. We constantly encounter and solve problems. We actually innovate. We do this all the time.” The innovation entrepreneurs do (but may not talk about) is the flip side of the innovation coin, disruptive innovation. Disruptive innovation provides solutions to problems by delivering new products to new markets – typically markets undiscovered and unknown at the time a new technology was conceived. Entrepreneurs possess the speed, focus, longer-term view and risk tolerance that makes them ideally suited to this form of innovation. What entrepreneurs do not have is an understanding of critical issues that might adversely affect customers’ interest in a new product or service. They also lack, initially, the capacity to scale. Better together Taken together, the respective strengths and weaknesses of larger organizations and startups point to a solution: partnership. Entrepreneurs could find in larger organizations the benefit of substantial industry insight, a capacity to scale and access to a customer or group of customers. Large organizations could find in entrepreneurs and the startups they create the benefit of speed, focus and risk tolerance that allows them to seed disruptive innovation outside the walls of the larger organization. Effective collaboration between large organizations and successful entrepreneurs is a big new idea. Successful entrepreneurs will tackle the world’s wicked problems supported from the start by larger organizations. Larger organizations will harness the speed, focus and risk tolerance of entrepreneurs, learning from and de-risking the disruptive innovation undertaken and supported through these new ventures. n

Colorado Medicine for January/February 2017

Features

Advancing technology Mary Anne Leach, director, Office of eHealth Innovation

Introducing the eHealth Commission and the Office of eHealth Innovation The eHealth Commission and the Office of eHealth Innovation (OeHI) were created by Gov. John Hickenlooper through executive order in late 2015, in recognition of Colorado’s unique opportunities to coordinate, leverage and continue advancing technology innovations across Colorado. Both the commission and the office are focused on advancing the effective use of health information technology and health data in support of our statewide efforts to improve quality, increase access, improve care coordination, reduce costs, and enhance the care experience and value for the citizens of Colorado. The eHealth Commission began meeting in early 2016 and currently has 14 members, including representation from primary care (a physician), behavioral care, rural care, and other key stakeholders like health systems, payers, consumers, health information exchanges, nonprofits and digital health leaders across Colorado. As we move forward with key health IT planning phases, we are further engaging our provider community in workshops that are focusing on key capabilities needed (for example, functionality or information that supports clinical workflows), as well as enablers needed (such as technology, data, standards, processes and policies). At some point, we may also form a provider and/ or multi-disciplinary ad-hoc working group(s) to help ensure that we’re most effectively meeting the needs of our clinical care community across the state. Please let us know if you’d be interested in participating.

In addition to supporting the commission and the planning workshops, the office has been managing a broader HIT planning process under the leadership of Carrie Paykoc, state HIT coordinator, and Chris Underwood, director, Office of Health Information. This process included a recent survey that reached many providers as well as key health care stakeholders. While we don’t know the exact response rate (due to the cascading manner in which the survey was distributed), it’s clear that we continue to have a very engaged health care community, including the 850 individuals who responded to the survey and the 376 who requested to be kept informed or volunteered to participate. The survey helped to prioritize key objectives that emerged from the early planning workshops and multistakeholder visioning sessions held in communities across Colorado. These objectives went into the community stakeholder survey process for prioritization and resulted in these top five priority focus areas: • Care coordination o Health care and health-related information needed for effective coordination of care across community services is easily accessible and usable throughout Colorado. • Access to information o Coloradans (and their authorized individuals and providers) can easily, appropriately and securely access health care and health-related information.

Colorado Medicine for January/February 2017

• Data integration and availability o Physical health, behavioral health, social services, payment and cost information is integrated and readily available and usable. • Cost of health IT o All providers have access to cost effective, health IT support and services that are aligned and realistic with their budgets and the value proposition of those service is clear and transparent. • Quality reporting o State-required quality measures are relevant to achieving Colorado’s State of Health Triple Aim – Best Health, Best Care, Best Value – and aligned across programs and settings, standardized and easy to report. There are other priority focus areas represented in the survey (respondents consistently said it was difficult to rank order them), and the office and commission recognize that these efforts need attention as well: broadband, telehealth, analytics, innovation, consent management, and governance and policy (which includes areas such as policies, standards, understanding of regulations, as well as transparent data sharing, correct patient and provider identification, and consent management). It’s clear that we have challenging and exciting work ahead of us, but with our public/private partnerships, our engaged stakeholders and communities, and the advancing technology enablers now at our dis-

OeHI (cont.) posal we’re optimistic that we’ll make tangible progress toward our goals.

Colorado Medical Society is pleased to announce Dynamic Physician Billing Solutions as our newest Corporate Supporter.

The Office of eHealth Innovation consists of the state HIT coordinator, Carrie Paykoc; intern Emily Geibel; our supporting team of HIT leaders, including Chris Underwood and other professionals housed in the Healthcare Policy and Financing Division; consulting partners; and me. We’re guided by our 14-member eHealth Commission.

Dynamic Physician Billing Solutions was “Created by a Doctor for Doctors.” We have combined our proprietary claims scrubbing software with our expert certified coders and billers to produce results our doctors expect. • Improve collections/cash flow by up to 35% • 98% AR collection rates and near zero denials • Comprehensive, customizable, easy-to-read reports Call us direct at 303-913-0508. Email info@dynamicphysicianbilling. com. Visit our website www.dynamicphysicianbilling.com

We welcome ongoing engagement with our provider community through the OeHI website, www.colorado. gov/oehi, where you can sign up for our newsletter, or by contacting us at maryanneleach@state.co.us or carrie. paykoc@state.co.us. We look forward to continuing our partnership with you, as we address our shared challenges and leverage technology innovations across the state of Colorado. n

Medical Division Banking Doctors...

Let the Bank Come to You!

Our Medical Relationship Bankers understand that medical professionals have unique banking needs that require specialized banking services. We can provide products and services that assist you in managing variable cash flow cycles, offer specialized financing options and deposit products to meet your business and personal financial needs - all while working with one dedicated relationship banker. We make house calls to you! Simplify Your Checking. Increase Your Cash Flow Efficiency and Security.

Banking Built on Relationships

16790 Centre Court • Parker, CO 80134 • Phone: 303-840-8484 Valerie Holden or Jason Naugle thechampionbank.com 16

Colorado Medicine for January/February 2017

Features

Health care innovation StartUp Health Colorado to create innovation hub in the Rocky Mountain Region to support health transformers StartUp Health Colorado and welcome its global community of Health Transformers,” said Colorado Gov. John Hickenlooper. “We’re seeing innovators flock to Colorado because there’s no better region for entrepreneurs to invent and grow.”

Howard Krein, MD, PhD Chief Medical Officer, StartUp Health StartUp Health Colorado, the second regional network affiliate of StartUp Health, launched in September 2016 to support and connect health innovation hubs around the state and the world. It will leverage three health institutions located on the University of Colorado Anschutz Medical Campus – Children’s Hospital Colorado, CU Anschutz and UCHealth – to create a health innovation hub in the Rocky Mountain Region for health entrepreneurs, “doctorpreneurs,” investors and industry stakeholders. Over the first three years, StartUp Health Colorado will collaborate with each institution to develop a custom innovation portfolio and plans to build, validate and commercialize at least 30 innovative health startups. These startups will be selected based on their alignment with the needs of each institution and their patient populations. “We are proud to see the launch of

“We’re excited to be a founding partner of StartUp Health Colorado along with other leading institutions in the area because together we can build one of the most advanced health innovation hubs in the U.S.,” said Gil Peri, senior vice president and chief strategy officer of Children’s Hospital Colorado. “Our vision is to speed up the pace of innovation by working collaboratively and to lead the way in supporting a generation of entrepreneurs and health practitioners to create meaningful solutions to help our patients.” “UCHealth is not only focused on innovating the advanced care we provide patients but also how we provide that care,” said UCHealth Chief Innovation Officer Richard Zane, MD. “By partnering with StartUp Health and with entrepreneurs who are developing and creating new innovations and technologies, we can make medical care more efficient, safe, accessible and convenient for patients.” “Colorado is emerging as a leading startup hub in the country,” said Kim Muller, director of CU Innovations at CU Anschutz. “StartUp Health is bringing their knowledge and experience of building early-stage health companies directly to the Rocky Mountain Region. We are confident that we will

Colorado Medicine for January/February 2017

build long-lasting relationships and partnerships with the entrepreneurs based right here in Colorado.” “This is truly a game-changing opportunity for health transformers,” said Steven Krein, co-founder and CEO of StartUp Health. “We’re excited to partner with the University of Colorado Anschutz Medical Campus and chose Colorado to expand StartUp Health because of the entrepreneurial spirit and health focus in the region. It’s entrepreneurs like Phillip Anschutz and leaders and creators like those at Children’s Hospital Colorado, CU Anschutz and UCHealth, who provide fuel for entrepreneurs to change the world.” Entrepreneurs and startups selected to join StartUp Health Colorado will receive opportunities to help commercialize and grow their businesses. They will also be invited to StartUp Health Academy, a lifetime coaching program, and receive ongoing access to StartUp Health’s network of over 30,000 industry leaders, investors and entrepreneurs. StartUp Health Colorado will co-locate with CU Innovations on the CU Anschutz Medical Campus in Aurora and leverage StartUp Health’s global infrastructure and operations. StartUp Health Colorado will receive additional support and funding through the Colorado Office of Economic Development and International Trade and the Advanced Accelerator Grant Program. Entrepreneurs interested in joining StartUp Health Colorado can learn more and apply at www.startuphealth. com/colorado. n 17

Features

Legislative preview Susan Koontz, JD, CMS General Counsel

Promoting health plan reform The Colorado Medical Society’s main focus in the 2017 legislative session is to promote health plan reform to salvage the deteriorating practice environment and remove patient hurdles to care. Physicians understand all too well the impact of health insurance mergers: the balance is skewed to put all the power in the hands of very few health plans. There is no market competition because of the concentration of power and physicians are forced to accept take-it-or-leave-it contracts. Practices and patients already face prior authorization and payment nightmares, and patients are losing their physicians due to narrowing networks with increasing physician deselections from networks without a clear explanation or appeal right as health plans chase the lowest cost point. There is no transparency by health plans regarding payment for out-of-network charges, with a pattern of the insurers using fraudulent databases to set rates. This history of fraud deteriorates trust of health plans; they must use an independent database. And the scant regulatory enforcement is biased in favor of the health plans. There are six issues for which CMS will advocate legislation to address these grave concerns. Issue 1: Out of network (OON) and surprise bills • Establish a fair and transparent solution to the OON network “surprise bills” issue. • Put a shared and fair responsibility for notifying patients on the facility, OON provider and health plan. 18

• Protect consumers from balance billing. • Establish a fair reimbursement rate for providers. • Set up a due process appeal for OON physicians to challenge “unfair reimbursement rates.” Issue 2: DOI complaints and dispute resolution • Require the commissioner of the Division of Insurance to investigate and resolve complaints from physicians regarding claim mishandling and inappropriate denials. • Include provider complaints in the annual report to the legislators. • Authorize the commissioner to financially penalize a health plan for a pattern of abuse. Issue 3: Selection/de-selection: Notification of patients and providers, transparent standards, appeal rights, the “Keep Your Physician” bill • Require transparency and fairness in health plans’ network construction (selection/de-selection process) and in the development of tiered networks. • Require health plans to communicate to physicians its standards for de-selection/selection and tiering of networks. • Require products identified as “value,” “high performing” or “quality” to have quality and not cost as the main criteria for selection/de-selection. • Prohibit discrimination against physicians serving rural areas or who are treating chronically ill patients that may cause higher than average costs.

Issue 4: Mergers – transparency and independent investigations For merger approvals, this bill would require foreign health plans (corporations formed in other states) to publicly disclose the Form E (the anticompetitive analysis conducted by the plan) and would require the DOI to conduct public hearings concerning the anticompetitive effects of the proposed merger. Issue 5: Protection from retaliation A bill on this issue would require the DOI commissioner to impose penalties for health plans engaging in patterns of abuse in retaliation for physicians informing regulators or legislators about the problems and concerns they face when dealing with health plans. Issue 6: Making telehealth work This bill aims to clarify the intent of the 2015 telehealth law. Health plans are interpreting the 2015 law to require physicians to use each health plan’s different telehealth vendors, forcing physicians to contract with numerous vendors and raising cost of health care, which was never the intent of the 2015 law. Stay connected The first regular session of the 71st Colorado General Assembly convened on Jan. 11, 2017. Watch for more on these issues. We encourage physicians to stay involved with CMS during the session. We will need physicians to testify in support of any of these issues. Email adrienne_abatemarco@cms.org or call 720-858-6322 to express your interest in testifying. n

Colorado Medicine for January/February 2017

Features

State budget considerations Ed Bowditch, Bowditch & Cassell Public Affairs

A $500 million budget gap will constrain legislative asks Colorado Gov. John Hickenlooper submitted his executive branch budget request for fiscal year (FY) 2017-18 on Nov. 1, 2016.

difference between required expenditures and available revenues. Current statute requires the following expenditures:

Status of Colorado economy Colorado’s economy continues to be among the best performing in the country. A recent economic forecast from the University of Colorado predicts that the state’s economic expansion will continue in 2017, led by hiring in construction, tourism and health care. Low energy and agriculture prices will temper the growth, however.

• Funding inflation and enrollment increases in K-12 education – $243 million. • TABOR refunds – $195 million. • Repayment of current-year reserve shortfall – $181 million. • Statutory transfers to transportation and capital – $164 million. • Paying for new Medicaid costs – $143 million.

Colorado budget process The governor makes his initial budget request in November for the fiscal year that starts the following July 1. The General Assembly, acting through the six-member Joint Budget Committee (JBC), will review each executive agency’s request and by early April will recommend a funding level for each line item in 20 state departments. The recommended budget will be based on available revenues, as Colorado is required to have a balanced budget.

Against these $926 million in expenditures, the executive branch economists project available new revenue of $426 million in new general fund dollars; that leaves a budget gap of $500 million.

Budget gap In preparing his budget request, Gov. Hickenlooper was constrained by the

State Budget Forecast Total Required Expenditures:

$926 million.

Total Projected Revenue: $426 million. Total Budget Shortfall: 20

$500 million.

To address this gap, the governor proposes to take the following actions. • Increase the K-12 negative factor by $46 million. • Reduce the statutory transfer to transportation by $109 million. • Reduce the Hospital Provider Fee revenues collected by the state by $195 million; this is recommended in order to eliminate the TABOR refund. • Transfer unspent employee compensation dollars by $47 million. Health care What does Gov. Hickenlooper recommend for health care in the budget request? One request is to increase the reimbursement for physicians at the University of Colorado Health Sciences Center – because those doctors, in a

public medical school, provide an essential source of primary and specialty care for Colorado’s Medicaid population. Frequently asked questions about the budget 1. Where does all of the marijuana tax money go? One recurring question is what Colorado does with all of the tax money it collects from marijuana sales. In FY 2016-17, Colorado is expected to collect approximately $105 million in tax revenue from the sale of legal and medical marijuana, and this revenue is allocated to three broad categories. • Approximately $55 million is allocated to K-12 education – both for school construction (as promised in the original initiative), health programs and dropout prevention. • Another $17 million is given to the Department of Human Services to address marijuana-related treatment programs. • Finally, the departments of Law, Public Health and Environment, Public Safety, and Revenue will receive approximately $30 million for enforcement activities. As you can see, those categories total $102 million; there is not a lot of state “profit” from legal marijuana. 2. Can the Hospital Provider Fee be changed? Colorado established the Hospital Provider Fee to increase revenues available to treat indigent patients. Hospitals pay the state, which in turn uses the revenues from the hospitals to draw down

Colorado Medicine for January/February 2017

Features additional federal Medicaid funds to be returned to the hospitals. However, in Colorado, unlike the 49 other states, we have the TABOR revenue limit, and the moneys given by the hospitals to the state count against the stateâ&#x20AC;&#x2122;s revenue cap. In the last two legislative sessions, there have been efforts to designate the Hospital Provider Fee as a TABOR enterprise but these efforts have failed. What the legislature can do is restrict the revenues collected from the hospitals. Thatâ&#x20AC;&#x2122;s what happened in FY 2016-17 and it is part of the governorâ&#x20AC;&#x2122;s request in FY 2017-18. 3. What about changes at the federal level? Given the election and inauguration of President Donald Trump, we can expect to see a lot of changes in federal health care. The timing of these changes is unknown, but changes to the Affordable Care Act and Medicaid are likely. n

Colorado Medicine for January/February 2017

Features

United-Rocky merger Kate Alfano, CMS Communications Coordinator

CMS urges DOI to strengthen United-RMHP agreement On Jan. 10, CMS President-elect Robert Yakely, MD, testified before the Colorado Division of Insurance (DOI) at a hearing in Grand Junction to provide comments and recommen-

dations on UnitedHealth Group’s proposed acquisition of Rocky Mountain Health Plans (RMHP). Physicians and patients throughout

Colorado and especially on the Western Slope are understandably concerned with the acquisition, specifically about long-term consequences it will have on patient care and how it will affect the long-standing relationships between RMHP and physicians that have been a model for the nation. As Yakely explained to the insurance commissioner, “The historical record of industry mergers demonstrates that whatever savings are realized through scaling efficiencies are not passed on to patients or their physicians. They simply give the health plans a bigger stick that exacerbates the already dangerous imbalances in physician-health plan business relationships, and clinical determinations.” Understanding that the acquisition is proposed because RMHP’s board of directors believes it is the best path forward to advance the company’s mission of community-based and coordinated care, the CMS board of directors voted to examine this transaction and its real-world impact on physicians and patients to determine opportunities to enhance the agreement and expand collaboration with the merged companies if approved by state regulators.

Top: CMS President-elect Robert Yakely, MD, testifies before the Colorado Division of Insurance to urge the agency to include conditions in UnitedHealth Group’s proposed acquisition of Rocky Mountain Health Plans to strengthen the agreement and maintain the positive gains of RMHP. Bottom: From right: Yakely; Gina Martin, MD, CMS board of directors member for the Southwest Rural district; and Elizabeth Soberg, CEO of UnitedHealthcare of Arizona, Colorado, New Mexico and Wyoming. 22

Based on extensive discussion and evaluation, including numerous listening sessions and outreach to Western Slope physicians, CMS strongly urged the insurance commissioner to strengthen the acquisition agreement in the following ways 1. Protect patients by prohibiting the merged company from passing

Colorado Medicine for January/February 2017

Features on acquisition costs to patients or other Colorado consumers in the form of higher premiums, as was a condition in United’s acquisition of PacifiCare in California. 2. Establish a Physician Advisory Committee comprised primarily of actively practicing Western Slope physicians to provide input during the transition and on any far-reaching management or medical policy changes. 3. Require the merged companies to offer a professionally facilitated dialogue to each Western Slope and mountain-region IPA currently

served by RMHP to enhance patient and community benefits. 4. Ensure continuity in leadership by guaranteeing employment of RMHP management, especially those who are involved in medical policy and physician relations. 5. Define “study, learn and apply” as United has said it will employ to implement RMHP best practices to the Front Range and around the country, and hold United accountable to this commitment to ensure positive outcomes.

unique in that both plans have been open and forthcoming with information about the transaction and plans for the future. CMS urges the DOI to accept these recommendations to ensure, if approved, that Western Slope patients and physicians continue to benefit from innovative health plan practices and collaboration. Go to www.cms.org for a link to the audio recording of the Jan. 10 hearing and to read the written testimony by CMS President Katie Lozano, MD, FACR, formally submitted to the DOI on Jan. 3. n

Yakely testified that this acquisition is

Top: The leadership of UnitedHealth Group and Rocky Mountain Health Plans address the DOI. Speaking (second from right) is RMHP President and CEO Steve ErkenBrack. Bottom left: Insurance Commissioner Marguerite Salazar listens to testimony at the hearing. Bottom right-top: Salazar and Yakely speak after the hearing. Bottom right-bottom: Yakely and ErkenBrack speak after the hearing. Colorado Medicine for January/February 2017

ght Greenlioffers proudly edical

do M Colora ers a memb y t e i c So t on

n discourvices our se

Discover the first mental health assessment tool that

immediately delivers test results for an informed diagnosis. Improve Patient Care: GreenLight tests serve as a first line of defense, an early warning system for the detection of mental illness. We provide physicians the opportunity to test and establish a baseline for all of their patients. Decrease Risk: Increased regulation and legal scrutiny, especially in prescribing pain medication, absolutely demands documentation of mental health testing to protect your practice. GreenLight provides a permanent detailed record of testing. Generate Revenue: GreenLight tests are typically covered by insurance, with the potential to generate thousands of dollars in additional revenue for your practice each month.

The new measure of mental health

Member Benefit Partner

“Without any training, we took the electronic tablet right out of the box and gave it to a patient. Her answers indicated she was suicidal... Because of GreenLight, we saved her life. I can’t think of a more powerful reason to use this technology.” Dr. Tomas Garcia, Cardiologist Houston, TX • President, Texas Medical Association

GreenLight, a division of StratMedical Inc. (866) 602-1778 • info@greenlight.md • greenlight.md

To get started, please visit www.greenlight.md today. 24

Colorado Medicine for January/February 2017

Features

Colorado working together Kate Alfano, CMS Communications Coordinator

CMS joins Colorado coalition on federal health care reform, advocates for Colorado physicians The Colorado Medical Society has been collaborating with a diverse working group of organizations formed by the Denver Metro Chamber, Health Advocates Alliance, and Colorado Consumer Health Initiative, to form a set of “common principles” on federal health care reform. The coalition is a partnership of more than 100 organizations representing counties, businesses, patients, people with disabilities, consumers, doctors, hospitals, insurers and others that demonstrates, once again, the “Colorado culture” of teamwork for the greater good. It was formed in response to a letter from U.S. House of Representatives leadership soliciting input from state governors and insurance commissioners on how to “strengthen and improve health care for all Americans.” The Trump administration and House Republican leaders have committed to bring substantial change to the national health policy framework. The Colorado coalition will “work to ensure, first, that these changes do not harm our state and its citizens and, second, that we improve on advances we have made where that is possible,” the coalition letter stated. It was sent to the Colorado congressional delegation on Jan. 4. As submitted, the principles were structured around two areas: The process Congress will follow to arrive at a new health care framework and the principles to which they will adhere with any new policy they enact.

The coalition put forth three guiding principles for the procedural stage: 1. Repeal the Affordable Care Act and related federal health policies only with a clearly identified and carefully considered replacement plan. 2. Address policy with the understanding of the interconnected nature of health care. 3. Find a bipartisan path to a new federal health care framework.

“Participating in a Colorado-based federal coalition expands our reach and influence, and we will continue to participate in future meetings,” said CMS President Katie Lozano, MD, FACR. She reported that the group was “very amenable to phrasing and construction preferred by CMS to ensure compatibility with our long-standing positions regarding health system reforms.” The coalition will reconvene in 2017 to discuss possible next steps to a collaborative stakeholder approach.

For the policy that is ultimately adopted: 1. Expand choice, affordability and competition in private markets while maintaining consumer protections. 2. Promote stability in the market to help control costs. 3. Acknowledge the benefits of promoting access to care at the right time and in the right setting. 4. Don’t shift cost to states without sufficient and sustained federal funding, or create an uneven playing field in the health care market. 5. Protect the most vulnerable, including children, seniors and people with disabilities. 6. Empower rural communities, recognizing that “one size fits all” does not apply to health care. 7. Encourage health care transformation at the state and community levels, funding and promoting innovative programs like those that Colorado has used to achieve significant improvements in the health care system.

Colorado Medicine for January/February 2017

Independent of the coalition, CMS provided guiding principles for health care reform and other policies to Gov. Hickenlooper and the insurance commissioner to help inform their response to the U.S. House leadership. “We are also working with our congressional delegation and closely coordinating with the American Medical Association to provide input on policy and respond to any needs or inquiries the delegation or individual members require,” Lozano said. The CMS board of directors convened a work session at the Jan. 20 meeting to assess the congressional dynamics, and members should expect to receive a series of flash polls to gauge reactions and concerns as the federal health care reform debate evolves. Stay tuned for more as the debate evolves. n

CMS .ORG CMS ORG CMS.ORG CMS ORG Colorado Medical Society

Features

Your opinion matters Troy Parks, AMA Wire®

How physician surveys impact major issues How many surveys have you been asked to take in the last year? Now, how many of those surveys seemed like they mattered? The Internet is flooded with surveys about anything and everything, but surveys directed toward physicians and focused on specific impact issues can actually make a difference. For the Colorado Medical Society, surveying physician members has brought a new element to advocacy efforts on major health care concerns. Benjamin Kupersmit, president of Kupersmit Research, joined forces with the Colorado Medical Society in 2008 to conduct a survey about comprehensive health care reform. Seeing tremendous value in the survey’s data, the parties continued their relationship and addressed many other issues such as network adequacy, physician-assisted suicide, Colorado’s attempt at a single-payer system, known as Amendment 69, and the Aetna-Humana and Anthem-Cigna mergers. “We’ve been able to use the surveys primarily to create a representative view of the voices not in the room when the board meets, the voices of the physicians who are too busy to show up and engage in that in-person level,” Kupersmit said. So how do they do it? “We always do some kind of a focus group with the people who are involved,” he said. “And we will always open up these focus groups to whomever wants to participate.” For example, when Amendment 69 was on the table in Colorado, they brought in both advocates and opponents to collect perspectives from both sides and create legitimate data that reflected the full opinion of the organization. The Colorado Medical Society finishes 26

the process of each survey with a report that is sent to all members. “We put it in the magazine, we put it online,” Kupersmit said. “There is no Starbucks gift card at the end of our surveys … our incentive for them is knowing that we close the loop and that they’re going to see that data.” With surveys popping up on everyone’s Internet browsers, how do you get the attention of physicians? According to Kupersmit, it’s quite simple. “[When] you put something out there on an issue that really matters … you can get a response,” he said. Surveys make a difference The society sent a survey to physician members to find out how they felt about the two major insurer mergers last year. “This survey set out to specifically create evidence of monopsony power and abuse by commercial payers as being experienced by our physicians,” Kupersmit said. The critical questions in this survey were directed toward the physicians who could cite specific challenges in contract negotiations that were hindering their ability to contract, authorize and be paid for their work. One of the questions asked was how the mergers would affect physicians’ abilities to negotiate contracts with the insurers. About 85 percent of the physician members said it would negatively affect their negotiations. This data was critical for the society in how it approached its opposition to the mergers. “It was very impactful,” Kupersmit said. “We asked our decision-makers, ‘Do you support or oppose the mergers?’” They found compelling evidence that the phy-

sicians on the ground were largely against them. Kupersmit pointed out an important part of choosing which issues to take a stance on or how to approach solutions after surveying physicians. You have to look at “the balance between [strong] and soft intensity of support or opposition,” he said. “When 63 [percent] strongly oppose and 16 [percent] somewhat oppose, that ratio is so tilted that we see that there’s passion, and in this case fear, frankly, if this merger was allowed to go through.” With Amendment 69, the Colorado Medical Society’s survey found that 67 percent of physicians across the state were strongly against the amendment and only 9 percent were strongly in favor. “What we found from our physicians is that [they] have little or no appetite … for a huge effort to restructure,” Kupersmit said. The results of this survey enabled the society to take a position on the issue. The AMA also conducted a survey, in collaboration with the California Medical Association, which was implemented in several other states and captured physicians’ opinions on the mergers. That data was sent to the U.S. Department of Justice (DOJ) and state attorneys general, led to meetings between the DOJ and practicing physicians and culminated in the opposition to the deals not only from several states, but also from the DOJ. The lesson: Physician voices have power. Last year, the AMA, in partnership with Dartmouth-Hitchcock Health Care System, conducted a time-motion study and found that for every hour of face-to-face time with patients, physicians spend nearly two hours on electronic health record

Colorado Medicine for January/February 2017

Features (EHR) and other clerical desk work. The study was supported by a qualitative component that surveyed physician opinions on the matter. Physiciansâ&#x20AC;&#x2122; responses were powerful and provided a valuable complement to the quantitative data. Anecdotes hold a lot of power, Kupersmit said. When you pair a powerful physician anecdote about how an issue is affecting patient care with strong data showing the opinion is shared by a large group of physicians, the package becomes something that is very hard to argue against. Another key collection of physician opinions comes out of the Physician Practice Benchmark Survey, conducted every two years. The AMA uses that data to support advocacy efforts to prevent burnout, make EHRs interoperable and fight for major issues identified in the survey results. When participation is high and responses are thoughtful, surveys can provide muchneeded support for efforts to change health policy and health care delivery. n Reprinted from AMA WireÂŽ wire.ama-assn.org/ CHC_WI_ECHOPainNetFracAd_CO_F120216.indd 1

Colorado Medicine for January/February 2017

12/2/16 10:45 AM

Features

Leveraging strengths

Heather Grimshaw, Communications Manager, Colorado State Innovation Model

SIM helps redefine behavioral health in primary care settings Whole-person health has become a tagline for health care providers who integrate behavioral health and primary care. They recognize the need to address a patient’s head and body to achieve the best health outcomes and are changing the way they practice medicine to accommodate that approach. Juniper Family Medicine in Grand Junction, Colo., is one of 100 practices in the Colorado State Innovation Model (SIM) that is integrating care and testing payment models to sustain those efforts. Since it started down this path, the care team is seeing positive results, including: • Helping a 10-year-old cope with suicidal inclinations, • Providing counseling services for a grief-stricken patient, and • Finding handicap-accessible housing for a patient to avoid homelessness. Intervention is key “We wanted to offer behavioral health support at the time of a doctor’s appointment, not as a separate, co-located service,” explains Kate Drackett, LCSW, a case manager at Juniper Family Medicine. “Because of SIM we were able to offer that service during office visits,” she adds. “I can be there in the moment for our patients when they need us.”

Meet the staff of Juniper Family Medicine. Front row, from left to right: Kay McMahon, physician assistant; Jennifer Berry, front desk staff; Kate Pierce, MD; Michelle Tonozzi, practice manager. Back row, left to right: Colette Grundy, medical assistant; Kate Drackett, LCSW. get to know me a little bit they’re more comfortable asking if they can visit.” Team huddles help determine which team members interact with patients and when. “We may go in together or, if a provider is running behind, I go in first knowing the game plan and a provider joins whenever he is available,” she says.

And needs vary, Drackett says.

Time is of the essence Knowing when to call behavioral health specialists into appointments can be difficult because you cannot always anticipate when that support will be needed or helpful.

“We talk about different ways to cope with depression and what it looks like to be anxious,” she explains. “As staff understand my scope and as patients

For example, if a diabetic patient isn’t following a provider’s recommendations, it might be “because a family member passed away and he or she is

dealing with grief,” Drackett says. “That is when [providers] need to pull me in.” Other scenarios fit more securely into a behavioral health bucket. For example, Drackett advocated on behalf of a young person who came in with severe acne and said he was being bullied in school. With the appropriate releases, Drackett talked with school guidance counselors and helped resolve the issue. “People normally present with things that are typically the tip of an iceberg or have some psychological component to it,” she says. The key is early identification and intervention.

Colorado Medicine for January/February 2017

Features Lessons learned When introducing Drackett to patients, clinicians find that an informal approach is best. “Team members don’t refer to me as a behavioral health person or a social worker,” she explains. “They just say, ‘This is Kate. She can help you figure out how to sleep a little better [as one example].’ There is still a stigma associated with [the words] behavioral health, mental health or social worker,” she adds. However, once a primary care provider tells a patient, “This is someone who can benefit you, the trust is transferred to me,” Drackett explains. “We don’t have a strict algorithm for when to bring in a behavioral health specialist. We just don’t want to miss anybody.” SIM will release its application for practices to join the second cohort this February. The initiative, which is funded by the Centers for Medicare and Medicaid Services, started in February 2016 and is expected to run through 2019. Additional resources: • Read the first article in the series: http://bit.ly/2jEbxaD • Learn more about the integration continuum and SIM: http://bit. ly/2ijUWai n

Now scheduling 2017 CMS Regional Forums! CMS leaders are ready to travel to your community for a homegrown meeting open to all physicians. CMS staff will work with you or your component on event planning and execution. Email president@cms. org or call 720-858-6321 Colorado Medicine for January/February 2017

Lead the way HONE YOUR SKILLS WITH THE COLORADO MEDICAL SOCIETY PHYSICIAN LEADERSHIP SKILLS SERIES

As changes in Colorado health care accelerate, it is more important than ever to have well-trained and active physician leaders guiding the way. That is why the Colorado Medical Society is launching the Physician Leadership Skills Series (PLSS) in January 2017. The series will feature eight innovative programs over the year aimed at deepening your awareness, developing crucial skills and equipping you with the tools and experience you need to lead tomorrow’s health care in Colorado.

Program Benefits BLENDED LEARNING APPROACH

CUTTING-EDGE PROGRAMMING

TRUSTED SOURCE

FREE TO CMS MEMBERS

This series will focus on knowledge and skills-based development using dynamic programming by experts in the field who have years of experience working with physicians. Each program can accommodate up to 100 physicians and participants can cycle in and out of programs based on interest and past experience.

The PLSS curriculum was developed based upon physician feedback and recognized gaps in physician business, management and leadership skills. Key topic areas include teamwork, negotiation, conflict management, facilitating meetings, persuasion, public speaking and best practices in board service.

The program is available free of charge to all current CMS members, including medical students and residents. A grant from the Physicians Foundation is helping to support the program.

MAKING THE MOST OF YOUR PRECIOUS TIME

PLSS uses short skills sessions and experiential learning to provide a robust program with a manageable time commitment. The programs will be held at convenient times, like Saturday mornings in person around the state or weeknights via video conference, to minimize disruptions in your practice.

! SIGN UP NOW When was the last time you did something for your professional and personal well being? Now is the time to follow through on the commitment to yourself and your profession. Continue your journey to excellence by developing and enhancing your leadership potential. Join with like-minded colleagues in a dynamic and interactive series where leadership meets medicine.

Learn more and register at www.cms.org/events/leadership-skills

Features

Leadership skills series Kate Alfano, CMS Communications Coordinator

Topics set for CMS Physician Leadership Skills Series As changes in Colorado health care accelerate, it is more important than ever to have well-trained and active physician leaders guiding the way. Thanks to a generous grant from the Physicians Foundation, the Colorado Medical Society is proud to present the Physician Leadership Skills Series (PLSS) to help enhance physician leadership capacity in Colorado and provide current and emerging physician leaders with the knowledge and skills they need to serve their patients, their practice, their profession and their community. The Physician Leadership Skills Series will feature eight innovative programs over the year aimed at deepening your awareness, developing crucial skills and equipping you with the tools and experience you need to lead tomorrow’s health care in Colorado. This series will focus both on knowledge and skills-based development using dynamic programming by experts in the field who have years of experience working with physicians. Participants can cycle in and out of programs based on interest and past experience. The curriculum was developed based upon direct physician feedback and recognized gaps in physician business, management and leadership skills. PLSS uses short skills sessions and experiential learning to provide a robust program with a manageable time commitment. The programs will be held at convenient times, like Saturday mornings in person around the state or weeknights via video conference, to minimize disruptions in your practice.

At CMS we live by the motto “by physicians for physicians.” We have been educating and engaging physician leaders for years. In fact, the skills series incorporates best practices and key lessons from another CMS flagship leadership develop initiative – the Advanced Physician Leadership Program – to provide a less time intensive, robust program to meet the needs of busy, practicing physicians. When was the last time you did something for your professional and personal well-being? Now is the time to follow through on the commitment to yourself and your profession. Continue your journey to excellence by developing and enhancing your leadership potential. Join with like-minded colleagues in a dynamic and interactive series where leadership meets medicine. The program is available free of charge to all current CMS members, including medical students and residents. Non-members are ineligible. Learn more at www. cms.org/events/leadership-skills. n

Colorado Medicine for January/February 2017

Program schedule, topics and locations Feb. 11, 2017, 8 a.m. - 12 p.m. (Denver) • Giving and receiving feedback • Building social capital March 6, 2017, 6 p.m. - 7:30 p.m. (Interactive online event) • Goal setting April 22, 2017, 8 a.m. - 12 p.m. - TBD • Multi-generational workplace June 2017 - TBD • Communicating through the media August 2017 (Interactive online event) • Delegation September 2017 - TBD • Power of a positive no • Engagement - physician and employee November 2017 - TBD • Best practices in board service • Meeting management

Inside CMS

CMS Corporate Supporters and Member Benefit Partners While CMS analyzes the quality and viability of our member benefit partners and their offerings, we do not guarantee any product or service will be right for you. Before you make a purchase, we recommend you perform your own due diligence.

AUTOMOBILE PURCHASE/LEASE US Fleet Associates 303-753-0440 or visit www.rmfainc.com * CMS Member Benefit Partner

MEDICAL PRACTICE SUPPLIES AND RESOURCES, CONT. RXAssurance Visit www.rxassurance.com or www.opisafe.com

FINANCIAL SERVICES COPIC Financial Service Group 720-858-6280 or visit www.copicfsg.com * CMS Member Benefit Partner

University of Colorado Hospital/CeDAR 877-999-0538 or visit www.CeDARColorado.org

Gold Medal Waters 720-887-1299 or visit www.goldmedalwaters.com LendKey â&#x20AC;&#x201C; Student Loan Refinancing 888-549-9050 or visit www.LKrefi.com/co-med * CMS Member Benefit Partner

Carr Healthcare Realty 303-817-6654 or visit www.carrhr.com Dynamic Physician Billing Solutions 303-913-0508 or visit www.dynamicphysicianbilling.com

Sharkey, Howes & Javer 303-639-5100 or visit www.shwj.com * CMS Member Benefit Partner

Eide Bailly 303-770-5700 or www.eidebailly.com/healthcare

INSURANCE PROGRAMS COPIC Insurance Company 720-858-6000 or visit www.callcopic.com *CMS Member Benefit Partner

First Healthcare ComplianceTM 888-54-FIRST or visit www.1sthcc.com *CMS Member Benefit Partner

UnitedHealthcare 877-842-3210 or visit www.UnitedhealthcareOnline.com MEDICAL PRACTICE SUPPLIES AND RESOURCES Colorado Drug Card 720-539-1424 or visit www.coloradodrugcard.com *CMS Member Benefit Partner

HealthTeamWorks 866-401-2092 or visit www.healthteamworks.com *CMS Member Benefit Partner Medical Telecommunications 866-345-0251, 303-761-6594 or visit www.medteleco.com * CMS Member Benefit Partner The Legacy Group at Re/MAX Professionals 720-440-9095 or visit www.legacygroupestates.com/physicians

CO-POWER 720-858-6179 or www.groupsourceinc.com *CMS Member Benefit Partner

TransFirst 800-613-0148 or visit www.transfirstassociation.com/cms *CMS Member Benefit Partner

GreenLight 866-602-1778 or visit www.Greenlight.md *CMS Member Benefit Partner

Transcription Outsourcing 720-287-3710 or visit www.transcriptionoutsourcing.net

MedjetAssist 1-800-527-7478, referring to Colorado Medical Society, or visit www.medjet.com/cms *CMS Member Benefit Partner 32

PRACTICE VIABILITY ALN Medical Management 866-611-5132 or visit www.alnmm.com

TSI 800-873-8005 or visit www.web.transworldsystems.com/npeters * CMS Member Benefit Partner

Colorado Medicine for January/February 2017

Inside CMS

In memoriam Kate Alfano, CMS Communications Coordinator

Richert E. Quinn Jr., MD April 18, 1941 - Jan. 11, 2017 Richert E. Quinn Jr., MD, passed away Jan. 11, 2017 at the age of 75. Quinn was a loving husband, father and grandfather; a respected general surgeon in Greeley who was instrumental in establishing and then leading the burn unit at the Weld County Hospital; a leader in the American Medical Association, Colorado Medical Society, Weld County Medical Society and Northern Colorado Medical Society; and a visionary who helped establish COPIC and contribute to its tremendous success. “Dr. Richert Quinn really believed in and embodied that we were part of a profession,” said Alan Lembitz, MD, COPIC’s chief medical officer, who got to know Quinn as a resident physician. “He taught that we had a special role and responsibility to our patients, but he also led by example that we as physicians had a duty to each other to make this profession of medicine better. Rich worked tirelessly in the ‘house of medicine,’ but also was just as dedicated one on one in what today we call mentoring.”

Richert E. Quinn Jr., MD

the CMS Council on Legislation during Quinn’s tenure as CMS president. “During that period we worked together closely on getting legislation on tort reform that has continued to protect Colorado physicians to this day. Rich was a leader in this effort and a visionary for our society in this area. He saw the need to form coalitions with other interested parties. It took several years to develop this coalition, but he never wavered in his effort to achieve this milestone goal much to the benefit of all the physicians of Colorado.” “Through his leadership and direction the delegation to the AMA was able to pass many strategic resolutions and elect numerous delegates’ important positions within the AMA,” said Ray Painter, MD, past president of CMS and a leader of the Colorado delegation to the AMA. “Dr. Quinn was a very trusted friend to many and liked by all for his commitment, humility and sense of humor.”

“Never at a loss for words, nor short of an opinion, Rich got things done sometimes by sheer force of will,” Lembitz continued. “I enjoyed his big heart, his self-deprecating sense of humor and his devotion to others. ‘If I see further today it is only because I stand on the shoulders of giants’ might seem like an odd hyperbole for this setting, but to me it defines what made Rich Quinn’s contributions and attitude special to our profession. He was a wise and good soul, and he will be missed.”

AMA Past President Jeremy Lazarus, MD, calls Quinn a true friend and mentor who was “unassuming, humble, tactically astute and collegial in a very special way.” Quinn helped Lazarus gain the experience needed to run for AMA office and then helped him achieve that office. “He led our AMA delegation with great dignity and was a trailblazer when he was elected to the AMA’s Council on Constitution and Bylaws. He went on to chair that council with the same solid performance that he had always shown,” Lazarus said.

Quinn served as CMS president in 1985-1986 and was elected a delegate to the AMA in 1986. CMS President-elect M. Robert Yakely, MD, was chairman of

Quinn joined the COPIC board in 1986 and served for nearly 10 years before stepping off to become the vice president of COPIC’s Risk Management

Colorado Medicine for January/February 2017

Department. Jerry Buckley, MD, past chairman and CEO of COPIC, credits Quinn with “raising the bar of patient safety and quality to such a degree in Colorado that it was considered the gold standard of medical liability insurance companies not only in the United States but worldwide.”

“‘If I see further today it is only because I stand on the shoulders of giants’ might seem like an odd hyperbole for this setting, but to me it defines what made Rich Quinn’s contributions special to our profession. He was a wise and good soul, and he will be missed.” - Alan Lembitz, MD, COPIC chief medical officer “Rich was the consummate risk manager, equally concerned for both the patient and the physician provider in any medical intervention,” Buckley continued. “His unique style of first telling you all the things you did correct captured your attention so you would be totally open to learn from what did not go as you anticipated. His love of medicine was only exceeded by his love for his wife, Carol, and children, Kevin and Shannon, and their beautiful children,” Buckley said. “I loved him, his sense of humor and have no one to replace his special charm.” n 33

Colorado Medicine for January/February 2017

Inside CMS

Ted J. Clarke, MD Chairman & CEO COPIC Insurance Company

Protecting against the threat of cyber attacks Among the emerging challenges in health care, cyber liability has gained a lot of attention. A 2016 study by Ponemon Institute1 found that health care organizations often “lack the money and resources to manage data breaches caused by evolving cyber threats, preventable mistakes and other dangers.” The study also estimates that data breaches could be costing the health care industry $6.2 billion. Why are medical practices a target for cyber crime? Health care entities have access to confidential and personal information, including medical records (electronic and paper), billing information (credit cards) and Social Security numbers. Compromised identities can be sold for as little as $50 each and can cost a practice at least $240 per year/per identity for the associated expenses after a data breach. What are the key risks? • Hackers, attackers and intruders: People who seek to exploit weaknesses in software and computer systems. • Malicious code: Computer code that is intended to cause undesired effects, security breaches or damage to a system. This can include: o Viruses: This code requires that you actually do something before it infects your system, such as open an email attachment or go to a particular webpage. o Worms: This code infiltrates systems without user interventions. They typically start by exploiting a software flaw. Then, once the victim’s computer is infected, the worm will attempt to find and infect other computers. o Trojan horses: Trojans hide in otherwise harmless programs on a computer, and much like the Greek story, release themselves when you’re not expecting it. For example, a program may claim to speed up your computer system, but it actually sends confidential information to a remote intruder. • Lost laptops and mobile devices: Laptops contain a vast amount of personal information on their hard drives and in temporary files. How are health care providers exposed? • Most breaches are caused by simple negligence • Loss/theft of mobile devices or electronic files cause 68 percent of breaches each year Colorado Medicine for January/February 2017

• Improper disposal of patient records • Rogue employees • Most sensitive data is not encrypted How does COPIC help protect against these threats? COPIC has embedded cyber liability coverage in our policies. In addition to addressing the risks previously mentioned, this coverage also addresses incidents that involve non-electronic (print) privacy breaches and patient identity exposures as well as business interruption issues. Actual de-identified examples of incidents we have dealt with include the following: A medical practice mistakenly placed one patient’s information on a prescription for another patient. A notification letter was sent to the patient whose information was disclosed, and the practice received no response from the patient. The incident was reported to the Office for Civil Rights and the practice completed an updated security risk assessment. Had the patient responded to the letter, the practice would have provided 12 months of identity theft protection. A medical practice had a power outage occur while its computers were backing up data. It led to a loss of data and the corruption of the files being saved. The computer issues were resolved, but the practice was unable to recover two days worth of data. A vendor was hired to assist with data recovery. No personal health information was compromised, but the practice experienced some business interruption. The data was able to be recovered and the practice was able to access the affected records and fully resume operations. In addition, COPIC Financial Service Group can offer expert assistance to review added levels of coverage and protection that may be appropriate for certain medical practices. COPIC recognizes that cyber risks are creating a new array of challenges where health care professionals need support. We continue to invest in resources such as a special report on data breaches (request a copy at www.callcopic.com/report). Staying at the forefront of emerging risks and offering practical guidance is one of the many ways we stand beside our insureds to help them prepare for the future of health care. n www.ponemon.org/blog/sixth-annual-benchmark-study-on-privacy-securityof-healthcare-data-1 1

Inside CMS

Reflective writing is an important component of the CU School of Medicine curriculum. Beginning in the first semester, medical students write essays, stories or poetry that reflect what they have seen, heard and felt. Reflections is edited by Steven Lowenstein, MD, MPH, and Tess Jones, PhD. It is dedicated to the memory of Henry Claman, MD, Distinguished Professor of the University of Colorado, founder of the Arts and Humanities in Healthcare Program, and original co-editor of this column.

Mi Tran University of Colorado School of Medicine

Mi Tran is an MD/MPH candidate for the class of 2018 at the University of Colorado School of Medicine. She is a Colorado native with an undergraduate degree in Molecular, Cellular, and Developmental Biology from the University of Colorado at Boulder. In her free time she enjoys hiking, rock climbing and camping with her dog, Oliver. She has a passion for primary care, public health and the pursuit of health equity.

Remembering third year Recently, I watched a documentary called Meru, about three men attempting to summit Meru peak in the Indian Himalayas. In it, one of the men says in jest, “The best alpinists are the ones with the worst memory.” In many ways, I think this quote also rings true for the third-year medical student. Sometimes, to continue trekking, it’s easier if we forget our previous traumas. And I’ve certainly had my fair share of those during this past year. I have been lost (both literally and figuratively), embarrassed and wrong, and I have had ubiquitous moments of self-doubt. Like those alpinists, I have forgotten much about the specifics of my academic traumas and follies, and with time and the gentle words of encouragement from friends and loved ones, my faith in myself is slowly restored. 36

Fortunately, what is cemented more deeply in memory are the people I have had the privilege of getting to know and care for, my greatest teachers over this past year, my patients – whom I have been heartbroken for, laughed with, celebrated with, learned from, and advocated for. Though I refer to them amorphously and collectively as “patients,” I remember them as individuals, each of whom have imparted on me a new and deeper understanding of humanity, and what it means to live a life in medicine. Though it is no doubt a life of great privilege, in the maelstrom of paperwork and the banality of everyday routine, it can be easy to forget that medicine is storytelling. The stories reflect our world in its rawest form, not only encapsulating the experience of inequality and human suffering, but also of great joy and compassion. It’s prose in the form of CT scans, biopsies, ultrasounds and vitals—the physical manifestations of the story of the inextricable entanglement between pathophysiology, politics and history. These stories are complex with origins that begin long before the point of diagnosis, reaching far beyond the scope of medicine. But in its complexity lies hope; hope in the possibility of transformation and hope in our own power to intervene. The interventions often do not require extreme technocratic solutions but can be simple acts that speak truth to power and reaffirm that health is a human right for all. Physicians are uniquely qualified for this task, because they are not only scribes in these stories but participants in them as well. As a medical student, someone who is freshly anointed into the world of medicine, I have been able to bear witness to the stories of people who have forever changed the trajectory of my own. The story of a man who confided in me that he feared his health care providers judged him for his bisexuality. A young refugee who disclosed a history of trauma and police brutality and her struggle to access mental health services. An uninsured mother with breast cancer seeking care for the first time only after deep ulcerations and a fungating mass had Colorado Medicine for January/February 2017

Inside CMS consumed almost the entirety of her left breast. I wonder how many stories just like these are being told every day. Rudolf Virchow described physicians as the “natural attorneys of the poor.” And after witnessing how often medical systems can largely contribute to the experience of what it is like to be poor, rather than alleviate it, I hope to uphold Virchow’s standard and to be an advocate for the many patients who may be poor or marginalized or whose voices are not heard or recognized. Lastly, in remembering the many patients I’ve encountered and who have touched my life, I hope to always remember that a listening ear, a compassionate touch, and comforting words leave a lasting impression and are worth investing time in. Doubtless, my optimism has taken a bit of a hit over this past year, but I remain certain that I have entered into a profession that will continue to work toward advancing the rights of all people, and I hope in some small way to be a part of that mission. n

Colorado Medicine for January/February 2017

Departments

medical news Board directs CMS to develop and distribute “End-of-Life Act” education to members The CMS Board of Directors approved a measure at their November meeting to educate physicians on the newly passed Proposition 106, the “Colorado End-of-Life Options Act,” which allows individuals with a terminal illness to request from their physician and selfadminister aid-in-dying medication. CMS will develop timely and accurate peer and legal-reviewed materials to educate physicians on the new law while carefully listening to and considering member concerns and recommendations. The CMS Council on Ethical and Judicial Affairs (CEJA) will lead this effort. Council members will: 1. Approve member educational materials; 2. Evaluate members’ concerns and make recommendations to strengthen physician and patient protections as needed and appropriate; 3. Work with the Colorado Medical Board and/or other state agencies on any guidelines that may be required

as a result of the law’s passage; 4. Coordinate closely with interested component societies for the purpose of assisting them with their work with local end-of-life grassroots initiatives; and 5. Maintain an ongoing assessment of the act’s impact on physicians and patients. The act became effective Dec. 16. The Colorado Department of Public Health and Environment (CDPHE) held a hearing on Jan. 18 on emergency docu-

mentation and reporting rules. The emergency rule went into effect but will be in place for no more than 120 days. CDPHE will work with stakeholders from January to March to adopt permanent rules in April 2017. The office of the CMS general council has prepared information physicians should know about the law. Go to www.cms.org to read this important summary that includes a sample form for patients to request aid-in-dying medication. n

Join Now!

Colorado Medical Political Action Committee Call 720-858-6327, 800-654-5653, ext. 6327, or email susan_koontz@cms.org

Colorado Medicine for January/February 2017

Departments

medical news CMS launches Central Line, a revolutionary, web-based communications platform In November, the Colorado Medical Society launched Central Line, a firstin-the-nation, web-based communications platform designed to empower all CMS members to engage with the medical society and inform the board of directors on the concerns and ideas of the membership. Central Line is easy, actionable and empowers members to: 1. Provide the board with your perspective before and after votes on policy at CMS board of directors meetings (no login required); 2. Give colleagues input on policy proposals they submit to CMS that are

of interest to you (no login required); and, 3. Submit policy proposals to CMS 24 hours a day, seven days a week instead of once a year at the Annual Meeting (login required).

your voting representative.

Central Line is a revolutionary application because it will provide you with an unparalleled voice in CMS with just a few clicks of a mouse or taps of a finger – all from the convenience of your desktop, laptop or mobile device. Central Line will make CMS a more grassroots, responsive and effective organization, and help the board members to be more informed, increasing their confidence as

Complete your Central Line profile to designate interest areas and tell CMS how you prefer to be contacted by logging on to www.cms.org/central-line. This is the only time you’ll ever need to log in except when submitting or checking on a policy proposal. Your participation will help CMS be the best state medical society for physicians in the country. n

AMA launches Silicon Valley integrated innovation company, Health2047 The American Medical Association has invested $15 million to become founding partner of a health care innovation company – Health2047, Inc. – that will conduct rapid exploration of innovative solutions to the biggest challenges facing the nation’s 1.1 million physicians and the patients they serve. “Improving the health of the nation is at the core of the AMA’s work and Health2047 will build partnerships to create new solutions for physicians and their patients that improve health care delivery and health outcomes,” said AMA Chief Executive Officer and Executive Vice President James L. Madara, MD, in a press release. Madera serves as Health2047’s board chair. “Health2047’s product orientation and entrepreneurial DNA will help forge new paths and bring commercial solutions to market faster.” A stand-alone, for-profit entity, Health2047 is an integrated innovation company that combines strategy,

design and venture disciplines, working in partnership with leading companies, physicians and entrepreneurs to improve health care. Its new Silicon Valley-based innovation studio will draw upon the AMA’s deep subject matter expertise and the organization’s unique relationship with physicians nationwide to develop new products, tools and resources that improve the practice of medicine and the delivery of health care to patients. Health2047 will collaborate with AMA content experts across a wide range of medical, health policy, and pragmatic practice areas. It will also integrate health care companies, technology companies and entrepreneurs to co-develop, create and spin out offerings that can have large-scale, systemic impact on health care and medical practice. The AMA’s financial commitment to establish Health2047 represents a major step in expanding its innovation ecosystem. Recently the AMA has integrated innovation into its work resulting in

Colorado Medicine for January/February 2017

internally generated physician-oriented digital tools as well as targeted engagement of health care startups. “Our investment in Health2047 tangibly underscores the AMA’s ongoing commitment to innovation and collaboration in health care. This dynamic new environment will include the physician perspective in every major innovation cycle, ensuring that physicians play a greater role in leading changes that will move health care forward,” Madara said in the release. Through its ongoing work, the AMA is providing opportunities for physicians to engage in innovation and share their ideas, expertise and real-world perspective on the effectiveness of technology in medical practice settings. From revitalizing medical practices to ensuring that digital health helps provide highquality patient care, the AMA is striving to help physicians navigate and succeed in a continually evolving health care environment. n 39

Departments

classified advertising Publication of any advertisement in Colorado Medicine is not an endorsement by the Colorado Medical Society of the product or service. Colorado Medicine magazine is the official journal of the Colorado Medical Society and is authorized to carry general advertising.

➤ PROFESSIONAL OPPORTUNITIES ➤ PROFESSIONAL OPPORTUNITIES ➤ PROFESSIONAL OPPORTUNITIES POSITION OPENING in January 2017 for a Primary Care/Family Practice physician in the beautiful town of Fountain, Colorado. This is a unique, ground-floor opportunity for an experienced Physician who is looking to get off of the treadmill of traditional medicine. Our organization is opening a practice dedicated to overall Oral and Systemic Health. You will be teamed with one of the most successful dentists in the community. This will be a separate yet integrated medical practice where treatment coordination with the dental team is a core tenet. Highly

competitive

salary,

full

ownership opportunity and fantastic benefits await the right individual. Requirements: 3-4 years post internship as a practicing general physician, Board Certification preferred, willingness to coordinate and collaborate with the owner of the dental practice, experience supervising mid-level providers preferred, and an active CO license. Clinic hours: 8a -5p, M-F. Contact Deb Packard for more information – packardd@pacden.com PART TIME EMPLOYMENT – MD / DO Description: Medical Doctor position immediately available in integrated

WESTMED FAMILY HEALTHCARE IS SEEKING A PART-TIME FAMILY PHYSICIAN Westmed Family Healthcare is a well-established Family Practice. We are currently seeking a part-time Family Physician to join our busy practice in a much sought-after location in Westminster Colorado to do strictly outpatient care with no OB. Westmed Family Healthcare offers a competitive salary, excellent benefits including a one-in-ten call schedule. Your work/life balance will be enhanced by a flexible work and call schedule. Please submit your resume to: lori@westmedfamilyhealthcare.com Lori Mehta Practice Manager, Westmed Family Healthcare 40

practice in Denver Tech Center. This physician will provide professional medical direction, oversight and direct patient care for the facility. The MD needs to: Be able to supervise a midlevel provider (NP/PA). Role of the MD in the Integrated Setting: The medical department is the portal of entry for all patients and all services. They are responsible for providing a variety of professional medical services including administering physical examinations, ordering x-rays, and performing injections as medically necessary. Email cpellow@msn.com or call 720-357-8350.

Encourage a colleague to join the Colorado Medical Society and your local medical society today! Visit www.cms.org to learn more about the benefits of becoming a member. For more information, call Tim at 720-858-6306 or email tim_yanetta@cms.org Colorado Medicine for January/February 2017

Compliments of:

Free Statewide Prescription Assistance Program The exclusive Rx program of the Colorado Medical Society

Attention! New Higher Discounts!

RETAIL PRICE

MEMBER PRICE

MEMBER SAVINGS

MEDICATION

QTY

Losartan 25mg

$43.19

$11.66

73%

Azithromycin 250mg Tab

$39.99

$18.68

53%

Amlodipine 5mg

$40.19

$9.84

75%

Hydrocodone/APAP 10-325mg 30

$23.09

$13.51

41%

Lorazepam 1mg

$55.99

$24.27

56%

Oxycodone/APAP 5-325mg

$23.99

$11.41

52%

Tramadol HCL 50mg

$34.69

$16.82

51%

NOTE: Our price is the average price members paid on that prescription during the month of January, 2015. Retail price was obtained by calling CVS/pharmacy. Pricing varies by pharmacy and by region. Prices are subject to change.

You can help by encouraging your patients to print a free Colorado Drug Card at:

www.coloradodrugcard.com

Customize the Colorado Drug Card for your practice!

Program Highlights: Free to all patients. Cards are pre-activated, no sign-up forms needed. Discounts on brand and generic medications. Helps patients that have high deductible plans or are uninsured. Reduces patient callbacks. Enhances physiciansâ&#x20AC;&#x2122; ability to treat patients with drugs that may not otherwise be affordable. HIPAA Compliant

For more information or to order your free personalized Colorado Drug Card please contact:

Milton Perkins - Program Director Colorado Medicine for January/February 2017 mperkins@coloradodrugcard.com Free Rx iCard

â&#x20AC;˘ 720-539-1424

Colorado Drug Card

Features

the final word We can reimagine health care together our industry. And what the members of this global innovation movement have learned is that we can reimagine health care together.

Mike Biselli, President, Catalyst HTI We’ve discovered something in the health care industry. There won’t be an Uber of health care. There won’t be a Netflix or an Airbnb, either. Unfortunately, the complexities of the U.S. health care system, and the multitude of regulations that crisscross it, have made the rapid, large-scale transformations that we’ve seen in transportation, entertainment and hospitality very hard to emulate in our industry. For a long time, health care executives believed this high barrier to entry would significantly delay the widespread disruption that was occurring elsewhere. Some even thought it might entirely prevent the digitization of the health care system. But those executives underestimated the ingenuity, determination and endurance of a growing number of clinicians, entrepreneurs, technologists, executives, administrators, patients, policymakers, academics and investors who are dedicated to transforming 42

In Colorado, more than 135 healthtech startups have been collaborating and competing within our innovation ecosystem for several years now to accelerate the digitization of the health care industry. Innovationfocused organizations like the Society of Physician Entrepreneurs, Colorado Emerging Medical Devices and Prime Health have been regularly convening the members of these startups at monthly gatherings – effectively turning our ecosystem into a community of innovators who are committed to working side by side to transform health care. From Boomtown and TechStars, to Innosphere and Innovation Pavilion, the accelerators and incubators within Colorado’s thriving innovation economy have been developing support programs tailored to meet the needs of these startups. Major academic institutions like the University of Denver and CU Anschutz have also started participating in our regional ecosystem, launching initiatives to enable their students to play a role in reimagining how care is delivered. All of this activity has occurred because the movement to transform health care through innovation cannot be stopped. The obstacles standing between innovators and the health care system have only galvanized our community, making us more and more willing to work together to overcome them. And that willingness

to collaborate has led to the creation of an entirely new feature of the innovation economy. For the past two years, my team and I have been developing Catalyst HTI, a first-of-its-kind, 180,000-square-foot industry integrator in Denver, Colo. By housing cutting-edge startups like Telespine, BurstIQ and Corvectra alongside established health care organizations like Kaiser Permanente, the American Diabetes Association and Medical Group Management Association, Catalyst HTI will encourage its members to work together to reimagine our industry – effectively integrating the health care system at the point of innovation. It’s the next step for our ecosystem. Yet while it’s been a source of great excitement for Colorado’s health innovators, Catalyst HTI is part of a broader project of industry integration, one in which regional innovation ecosystems are consolidated within industry integrators across the country – essentially turning these regional ecosystems into enduring sites of transformation for our industry. Take a moment to imagine what will be possible. Consider how quickly health care will change with a network of industry integrators spread across the nation. We’re already doing it in Colorado. And the same integration of startups and established organizations occurring here can occur anywhere. All that’s required is a desire to reimagine health care, and a willingness to work together. n

Colorado Medicine for January/February 2017

ARE YOU

OVERPAYING FOR YOUR OFFICE LEASE?

Over 80% of healthcare professionals believe they pay too much. We agree. We can help. Our expertise is provided at no cost to our clients, saving them time and money during lease negotiations.

Call today for your free lease or purchase evaluation. DENVER Perry Bacalis | 303.945.5270 perry.bacalis@carrhr.com

CARRHR.COM

NORTHERN COLORADO Dan Gleissner | 303.748.7905 dan.gleissner@carrhr.com

SOUTHERN COLORADO Kent Hildebrand | 719.440.0445 kent.hildebrand@carrhr.com

| ONLY HEALTHCARE. ONLY TENANTS AND BUYERS. TM