On May 18, 2022, Governor Polis signed House Bill 22-1325 (HB 22-1325) into law, which directs the DOI to establish aligned parameters for primary care alternative payment models (APMs), to improve health care quality and outcomes in a manner that reduces health disparities and actively advances health equity, and increases the number of Coloradans who receive the right care in the right place at the right time at an affordable cost. The DOI will develop the aligned APM parameters in partnership with the Department of Health Care Policy and Financing, the Department of Personnel, the Department of Public Health and Environment, the Primary Care Payment Reform Collaborative (PCPRC), and health insurance carriers and providers participating in APMs.
Prior to developing and promulgating a rule to establish aligned APM parameters (by December 1, 2023), the Division is engaging with a broad array of stakeholders. PCPRC meetings will serve as an initial focal point for discussions, but additional discussions with carriers, providers, and consumers outside of the Collaborative will also take place. The following table presents the timeline for stakeholder engagement around four key topic areas (quality measures, patient attribution, risk adjustment, and core competencies.
* * * Stakeholder Engagement Timeline * * *
If you are interested in adding your name to the stakeholder engagement email distribution list for HB 22-1325 implementation, please send your name and contact information to Tara Smith, the Division's Primary Care and Affordability Director (tara.smith@state.co.us).
Quality Measures
Quality Measure Stakeholder Engagement Group
The aligned APM parameters for primary care must include, per the requirements of HB22-1325, an aligned quality measure set that considers the quality measures and the types of quality reporting that health insurance carriers and providers are engaging in under current state and federal law. In addition, the aligned quality measure set must include quality measures that are patient-centered and patient-informed and address: pediatric, perinatal, and other critical populations; the prevention, treatment, and management of chronic diseases; and the screening for and treatment of behavioral health conditions.
The Division, with the support of the Health Care Payment and Learning Action Network (HCP LAN), held a series of stakeholder meetings in January 2023 to obtain input on aligned quality measure sets for adult and pediatric populations:
- January 17 - Payers
- January 26 - Providers
- January 27 - Consumers
- March 1 - Review of measure sets
- March 29 - Technical specifications
Quality Measures - Stakeholder Meeting Materials Quality Measures - Technical Specifications
Patient Attribution
Patient Attribution Stakeholder Engagement
The aligned APM parameters for primary care must include, per the requirements of HB22-1325, utilize patient attribution methodologies that are transparent and reattribute patients on a regular basis. Patient attribution methodologies must also ensure that population-based payments are made to a patient's primary care provider rather than other providers who may only offer sporadic primary care services to the patient, and include a process for correcting misattribution that minimizes the administrative burden on providers and patients.
The Division, with the support of the Health Care Payment and Learning Action Network (HCP LAN), hosted an initial stakeholder meeting on Tuesday, April 25, 2023 to obtain input on aligned attribution methodologies for primary care APMs. A follow-up session is scheduled for May 17, 2023, from 3-4 pm MT.
Interested stakeholders can register for the May 17 meeting at the following link:
Stakeholders are also invited to complete a brief survey related to patient attribution, either before or after the April 25 meeting, by clicking on the button below.
Patient Attribution Stakeholder Meeting Materials Patient Attribution Survey
Risk Adjustment
Risk Adjustment Stakeholder Engagement
The aligned APM parameters for primary care must include, per the requirements of HB22-1325, include transparent risk adjustment parameters that ensure that primary care providers are not penalized for or disincentivized from accepting vulnerable, high-risk patients. Risk adjustment parameters must also ensure primary care providers are rewarded for caring for patients with more severe or complex health conditions, and patients who have inadequate access to affordable housing, healthy food, or other social determinants of health.
The Division, with the support of the Health Care Payment and Learning Action Network (HCP LAN), will be hosting a second stakeholder meeting on Wednesday, July 19, 2023 from 9:00-10:00 am MT to obtain input on aligned attribution methodologies for primary care APMs.
Interested stakeholders can register for the July 19 meeting at the following link:
Core Competencies
Core Competencies Stakeholder Engagement
The aligned APM parameters for primary care must include, per the requirements of HB22-1325, include a set of core competencies around whole-person care delivery that primary care providers should incorporate in practice transformation efforts to take full advantage of various types of alternative payment models.
The Division, with the support of the Health Care Payment and Learning Action Network (HCP LAN), will be hosting a stakeholder meeting on Tuesday, August 8, 2023 from 3:00-4:00 pm MT to obtain input on aligned attribution methodologies for primary care APMs.
Interested stakeholders can register for the August 8 meeting at the following link: