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Primary Care Payment Reform Collaborative

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

*   *  NOW ACCEPTING APPLICATIONS FOR NEW MEMBERS - PLEASE CLICK HERE TO COMPLETE AN APPLICATION FORM  *  *

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 HB 19-1233 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. 

2024 Meetings

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2024 Meeting Calendar for the Primary Care Payment Reform Collaborative

Until further notice, all Collaborative meeting will be REMOTE ONLY. Reasonable accommodation will be provided upon request for persons with disabilities. If you are a person with a disability who requires an accommodation to participate in a Collaborative meeting, please notify Tara Smith at 720-701-0081 or tara.smith@state.co.us at least one week prior to the meeting. Please register for upcoming meetings in 2024 using the following link: 

Register for 2024 Collaborative Meetings

 

May 9, 2024

Agenda - 5.9.24

The Financialization of Health in the United States - New England Journal of Medicine, January 11, 2024

Vertical Integration and the Transformation of American Medicine - New England Journal of Medicine, March 14, 2024

Private Equity-Acquired Physician Practices and Market Penetration Increased Substantially, 2012-21 - Health Affairs, March 2024

Geographic Penetration of Private Equity Ownership in Outpatient and Residential Behavioral Health - JAMA Psychiatry, May 1, 2024

Evaluating Trends in Private Equity Ownership and Impacts on Health Outcomes, Costs, and Quality: Systematic Review - BMJ, July 2023

Physicians in Private Equity Practices- Canaries in a Coal Mine? - JAMA Internal Medicine, March 11, 2024 

April 11, 2024

Agenda - 4.11.24

Slide deck - 4.11.24

Third Annual Recommendations Report - December 2021 - PCPRC; Pgs. 9-12

Making Equity Primary in the Making Primary Care Model - Health Affairs, Aug 21, 2023

March 14, 2024

Agenda - 3.14.24

Slide deck - 3.14.24

DRAFT meeting minutes - 3.14.24

Health of US Primary Care - 2024 Scorecard Report- Milbank Memorial Fund and Physicians Foundation - Feb 2024

Health of US Primary Care - 2024 Scorecard Report APPENDIX - Milbank Memorial Fund and Physicians Foundation - Feb 2024

2024 PCPRC Priorities - Google Forms

February 8, 2024

Agenda - 2.8.24

Slide deck - 2.8.24

DRAFT meeting minutes - 2.8.24

DRAFT Full Report

January 11, 2024

Agenda - 1.11.24

Slide deck - 1.11.24

DRAFT meeting minutes - 1.11.24

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Sunset Review

The Colorado Office of Policy, Research and Regulatory Reform is currently conducting a sunset review of the Primary Care Payment Reform Collaborative as described in section 24-34-104 of the Colorado Revised Statutes.  Analysis is performed to determine if the collaborative is necessary and should be continued or repealed.  To provide input on this review, please visit: https://coprrr.colorado.gov/participate.

Members

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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.
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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:

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  • 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.
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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.

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Current Collaborative Members

Polly Anderson - Health Care Provider, Denver Metro Area

Brandon Arnold - Health Insurer , Denver Metro Area

Josh Benn - Colorado Department of Personnel and Administration

Isabel Cruz - Health Care Consumer, 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

Anne Ladd - Health Care Consumer and Purchaser, Mountain and Southwest Colorado

Cassana Littler - Primary Care Provider, Denver Metro Area

Amanda Massey - Health Insurer, Denver Metro Area

Miranda Ross - Health Insurer, Denver Metro Area

Lisa Rothgery - Health Care Provider, Denver Metro Area

Amy Scanlan - Health Care Provider, Denver Metro Area

Jack Teter - Health Care Provider, Denver Metro Area

Patricia Valverde - Health Care Consumer, Denver Metro Area

Peter Walsh - Colorado Department of Health Care Policy & Financing

Annual Recommendation Reports

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Multi-Payer Alignment

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House Bill 22-1325 Implementation

On May 18, 2022, Governor Polis signed HB 22-1325 into law, which directed the DOI to establish aligned parameters for primary care alternative payment models (APMs) 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 Colorado Insurance Regulation 4-2-96, Concerning Primary Care Alternative Payment Model Parameters, the Division engaged with a broad array of stakeholders.

 

Information about these stakeholder meetings, as well as ongoing implementation of HB22-1325, is available on the Division's HB22-1325: Primary Care Alternative Payment Models website

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).

Colorado Multi-Stakeholder Symposium - June 2023

On June 30, 2023 , the Colorado Division of Insurance hosted a Multi-Stakeholder Symposium, in partnership with the University of Colorado Practice Innovation Program. This even brought together  payers, providers and practice staff to build relationships, find common values, and work toward healthcare payment models that work for all stakeholders – patients, physicians, advanced practice providers, health systems, payers, employers and patients. To achieve the goal of improved care at a lower cost with an improved experience of care by patients and health care teams, extensive collaboration will be essential. A goal of the Multi-Stakeholder Symposium was to align payers, both public and private, around alternative payment models that enable primary care to deliver Advanced Primary Care. A final report, summarizing key themes from meeting, is available in English and in Spanish, by clicking on the boxes below. Recordings of panel discussions are available on the University of Colorado Department of Family Medicine Practice Innovation Program website. 

CO Multi-Stakeholder Symposium Report - English           CO Multi-Stakeholder Symposium Report - Spanish

Colorado Alternative Payment Model (APM) Alignment Initiative

Starting in the Fall/Winder of 212, Colorado embarked on a process to develop a multi-payer statewide alternative payment model (APM), with the goal of aligning payers' efforts to shift away from fee-for-service payments to value-based payments. A statewide aligned health care APM has the potential to reduce administrative burden for providers, increase health care value, and improve quality and health equity for consumers. 

In order to achieve these goals, the Office of Saving People Money on Health Care in the Lieutenant Governor's Office partnered with the Department of Health Care Policy and Financing (HCPF), the Division of Insurance (DOI), and the Department of Personnel and Administration (DPA) to host a series of stakeholder conversations. 

 

Additional information about these discussions, including Work Group meeting materials and a Final Recommendations Report, are available on the Colorado Alternative Payment Model (APM) Alignment Initiative website. 

Past Meeting Materials

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2023 Meetings
December 14, 2023
November 9, 2023
October 12, 2023
September 14, 2023
August 10, 2023
July 13, 2023
June 8, 2023
May 11, 2023
April 13, 2023
March 9, 2023
February 9, 2023
January 12, 2023
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2022 Meetings
December 7, 2022
November 17, 2022
October 21, 2022
September 15, 2022
August 10, 2022
July 14, 2022
June 14, 2022
May 12, 2022
April 13, 2022
March 17, 2022
February 15, 2022
February 3, 2022
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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
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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
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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
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For more information about the Collaborative, contact Tara Smith, Primary Care and Affordability Director - tara.smith@state.co.us; 720-701-0081.