Primary Care Payment Reform Collaborative

House Bill 19-1233 established a Primary Care Payment Reform Collaborative (the Collaborative) led by the Colorado Division of Insurance (DOI).

 

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The Collaborative focuses on developing strategies for increased investments in primary care that deliver the right care in the right place at the right time, and advise in the development of affordability standards and targets for carrier investments in primary care. Created through HB19-1233 and convened by the Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), has been meeting since July of 2019 to develop recommendations aimed at increasing investments in high-quality primary care. Increased investment can lead to better access, and access to primary care is a key part of our health care system. 

Annual Recommendation and Other Reports

Each year, the Collaborative publishes a report of primary care payment reform recommendations, which is available to the public. Since its creation in July 2019, the Collaborative has released three annual reports, as well as a set of recommendation around the use of telehealth to support primary care delivery:

Members

What does the Collaborative do?

In addition to focusing on the development of strategies for increased investments in primary care leading to delivery of the right care in the right place at the right time, the Collaborative is working towards strategies that:

  • Reduce health care costs resulting in net savings;
  • Are evidence-based and provide incentives for value rather than volume;
  • Are adequate to sustain infrastructure to deliver advanced primary care that is patient-centered, comprehensive, coordinated, and accessible;
  • Direct resources to the patient and practice level that expand the capacity of the primary care system to equitably meet the health needs of patients; and
  • Sustain advanced primary care delivery models.

The Collaborative also works with various groups and organizations, while developing other recommendations and reports regarding primary care. At a high level, the Collaborative engages in the following:

  • Consult with the Department of Personnel, the Department of Health Care Policy and Financing (HCPF), and the Colorado All-Payer Claims Database (APCD);
  • Advise in the development of broad based affordability standards and targets for carrier investments in primary care;
  • Coordinate with the APCD to analyze the percentage of medical expenses allocated to primary care by insurers, Health First Colorado (Colorado’s Medicaid Program), Children’s Health Plan Plus (CHP+);
  • Develop a recommendation to the Insurance Commissioner on the definition of primary care for these purposes;
  • Report on current health insurer practices and methods of reimbursement that direct greater health care resources and investments toward health care innovation and care improvement in primary care;
  • Identify barriers to the adoption of alternative payment models by health insurers and providers and develop recommendations to address these barriers;
  • Develop recommendations to increase the use of alternative payment models that are not fee-for-service in order to:
    • Increase investment in advanced primary care delivered by practices that are Patient Centered Medical Homes or practices that have demonstrated ability to provide high-quality primary care;
    • Align primary care reimbursement by all consumers;
    • Direct investment toward higher-value primary care services with an aim at reducing health disparities;
  • Consider how to increase investment in advanced primary care without increasing costs to consumers or increasing the total cost of health care; and
  • Develop and share best practices and technical assistance to health insurers and consumers.

Participants in the Collaborative are asked to commit 4-6 hours per month. Additional information regarding the Collaborative's administrative operations are outlined in the Primary Care Payment Reform Collaborative's Standard Operating Procedures and Rules of Order.

Current Collaborative Members

Dustin Allison - Center for Medicare & Medicaid Innovation, Centers for Medicare and Medicaid Services

Isabel Cruz - Health Care Consumer, Denver Metro area

David Ducharme - Colorado Department of Health Care Policy & Financing

Stephanie Gold - Primary Care Provider, Denver Metro area

Patrick Gordon - Health Insurer Representative, Western Slope

John Hannigan - Acting Regional Director, Region VIII, U.S. Department of Health and Human Services

Steve Holloway - Colorado Department of Public Health & Environment

Lauren Hughes - Health Care Provider, Denver Metro area

Rajendra Kadari - Health Care Provider, Denver Metro area

David Keller - Primary Care Provider , Denver Metro area

Kyra deGruy Kennedy - Health Care Consumer, Denver Metro Area

Gretchen McGinnis - Health Insurer Representative, Denver Metro area

Chris Riley - Health Insurer Representative, Denver Metro area

Miranda Ross - Health Insurer Representative, Denver Metro area

Simon Smith - Primary Care Provider, Northern Front Range

Kari Snelson - Health Insurer Representative, Northeast Colorado

Jack Teter - Health Care Provider, Denver Metro area

Marsha Thorson - Primary Care Provider, Western Slope & Mountain Communities

Past Meeting Materials

2021 Meetings
Dec. 7, 2021
Nov. 17, 2021
Oct. 14, 2021
Sept. 13, 2021
Aug. 12, 2021
July 12, 2021
June 15, 2021
May 13, 2021
April 13, 2021
March 8, 2021
Feb. 9, 2021
Jan. 19, 2021
2020 Meetings
Dec. 7, 2020
Nov. 19, 2020
Nov. 2, 2020
Oct. 13, 2020
Sept. 21, 2020
Sept. 1, 2020
Aug. 10, 2020
July 7, 2020
June 11, 2020
May 18, 2020
April 29, 2020
March 17, 2020
Feb. 27, 2020
Jan. 14, 2020
2019 Meetings
Dec. 12, 2019
Dec. 2, 2019
Nov. 12, 2019
Oct. 22, 2019
Sept. 30, 2019
Sept. 10, 2019
Aug. 19, 2019
July 31, 2019
July 8, 2019

For more information about the Collaborative, contact Tara Smith, Primary Care and Affordability Director - tara.smith@state.co.us; 720-701-0081.