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).

 

*   *  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. 

Collaborative Releases Fourth Annual Recommendation Report

February 15, 2023 - The Collaborative is please to release the Fourth Annual Recommendations Report. Since its creation in July 2019, the Collaborative has released an annual report of findings and recommendations on how to strengthen Colorado’s primary care system through increased investments in advanced primary care delivery and the use of alternative payment models. House Bill 22-1325- change the date of publication of the report from December 15 to February 15. The Fourth Annual Recommendations Report can be accessed by clicking on the following button:

Fourth Annual Recommendations Report - February 2023 - Primary Care Payment Reform Collaborative

House Bill 22-1325 Implementation

On May 18, 2022, Governor Polis signed HB 22-1325 into law, which directs 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 a rule to establish aligned APM parameters (by December 1, 2023), the Division is engaging with a broad array of stakeholders. 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).

*  *  *  For additional information regarding the HB22-1325 implementation, please visit the Division's HB22-1325: Primary Care Alternative Payment Models webpage. *  *  *

2023 Meetings

2023 Meeting Calendar for the Primary Care Payment Reform Collaborative

Until further notice, all Collaborative meeting will be REMOTE ONLY - please register for upcoming meetings in 2022 and 2023 using the following links: 

 

Register for 2023 Collaborative Meetings

May 11, 2023

Agenda - 5.11.23

Slide deck - 5.11.23

Scaling Behavioral Health Integration in Primary Care: Wading through the Complexity to Tackle a Decades-Old Challenge - Network for Excellence in Health Innovation, March 2023

Association of Integrating Mental Health Into Pediatric Primary Care at Federally Qualified Health Centers With Utilization and Follow-up Care - JAMA, April 26, 2023

Integrating Behavioral Health Services into Primary Care - Commonwealth Fund, December 14, 2022

Colorado Multi-Payer Collaborative: Lessons Learned for Primary Care Improvement - Milbank Memorial Fund, April 2023

April 13, 2023

Agenda - 4.13.23

Slide deck - 4.13.23

DRAFT meeting minutes - 4.13.23

Corporate Investors in Primary Care - Profits, Progress, and Pitfalls - NEJM, 1.12.23

Sick Profit: Investigating Private Equity's Stealthy Takeover of Health Care Across Cities and Specialties - Kaiser Health News, 11.14.22

Mitigating the Price Impacts of Health Care Provider Consolidation - Milbank, Sept 2021

Accountable Care in 2023: Evolving Terminology, Current State, and Priorities - Health Affairs, 2.24.23

Differences in Use of Services and Quality of Care in Medicare Advantage and Traditional Medicare, 2010 and 2017 - Health Affairs, April 2023

Medicare Advantage Risk Adjustment Data Validation (RADV) Final Rule - Milliman, 2.8.23

March 9, 2023

Agenda - 3.9.23

Slide deck - 3.9.23

DRAFT meeting minutes - 3.9.23

February 9, 2023

Agenda - 2.9.23

Slide deck - 2.9.23

Meeting minutes - 2.9.23

2022 Primary Care Payment Reform Collaborative Full Draft Report 2.3.23

January 12, 2023

Agenda - 1.12.23

Slide deck - 1.12.23

Meeting minutes - 1.12.23

2022 Primary Care Payment Reform Collaborative Full Draft Report 1.6.23

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

Polly Anderson - Health Care Provider, Denver Metro Area

Brandon Arnold - Health Insurer , Denver Metro Area

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

Kyra deGruy Kennedy - Health Care Consumer, 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

Kari Snelson - Health Insurer, Northeast Colorado

Jack Teter - Health Care Provider, Denver Metro Area

Peter Walsh - Colorado Department of Health Care Policy & Financing

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:

Past Meeting Materials

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

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.