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. 

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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), 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 will be 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 a proposed timeline for stakeholder engagement around four key topic areas (quality measures, patient attribution, risk adjustment, and core competencies.

Please email comments or feedback on this proposed time to Tara Smith (tara.smith@state.co.us) by September 30, 2022

 

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).

2022 Meetings

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2022 Meeting Calendar for Primary Care Payment Reform Collaborative

Until further notice, all Collaborative meeting will be REMOTE ONLY - please register for upcoming meetings in 2022 using the following link (NOTE: You must register separately for the October 21 meeting): 

Register for Sept, Nov, and Dec 2022 Collaborative Meetings

Register for Oct 21, 2022 Collaborative Meeting

September 15, 2022

Agenda - 9.15.22

Slide deck - 9.15.22

Risk Adjustment Based on Social Factors: State Approaches to Filling Data Gaps - State Health Value & Strategies

Payment Structures that Support Social Care Integration with Clinical Care: Social Deprivation Indices and Novel Payment Methods - American Journal of Preventive Medicine

Neighborhood socioeconomic disadvantages is associated with multimorbidity in a geographically-defined community - BMC Public Health

UMass Risk Adjustment Project for MassHealth Payment and Care Delivery Reform: Describing the 2017 Payment Model - UMass Medical School Center for Health Policy and Research

Maryland Primary Care Program: HEART Payment Playbook 2022 - Maryland Primary Care Program (MDPCP)

At the Intersection of Risk Adjustment and Social Determinants of Health - Society of Actuaries Health Watch

August 10, 2022

Agenda - 8.10.22

Slide deck - 8.10.22

Patient Attribution: The Basis for All Value-Based Care - Society of Actuaries

Accelerating and Aligning Population-Based Models: Patient Attribution - Health Care Payment Learning & Action Network

DRAFT meeting minutes - 8.10.22

July 14, 2022

Agenda - 7.14.22

Slide deck - 7.14.22

Person-Centered Primary Care Measure - v 2..1 English

Clinical Quality Measures in a Post-Pandemic World: Measuring What Matters in Family Medicine - Annals of Family Medicine, July/August 202

Why Quality Measures Do Not Measure Quality - Center for Healthcare Quality and Payment Reform

DRAFT meeting minutes - 7.14.22

June 14, 2022

Agenda - 6.14.22

Slide deck - 6.14.22

The Building Blocks of Behavioral Health Integration - FRAMEWORK

The Building Blocks of Behavioral Health Integration - REPORT

DRAFT meeting minutes - 6.14.22

May 12, 2022

Agenda - 5.12.22

Slide deck - 5.12.22

Health Equity and Value-Based Payment Systems- Moving Beyond Social Risk Adjustment - Health Affairs 7.28.21

Provider payment- what does risk adjustment have to do with it - Milliman 3.18.16

Meeting minutes - 5.12.22

April 13, 2022

Agenda - 4.13.22

Slide deck - 4.13.22

DRAFT meeting minutes - 4.13.22

March 17, 2022

Agenda - 3.17.22

Slide deck - 3.17.22

DRAFT meeting minutes - 3.17.22

February 15, 2022

Agenda - 2.15.22

Slide deck - 2.15.22

Meeting minutes - 2.15.22

February 3, 2022

Agenda - 2.3.22

APM Alignment Primary Care Sub-Group Meeting 1.13.22 - Slide deck

Slide deck - 2.3.22

Meeting minutes - 2.3.22

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

Isabel Cruz - Health Care Consumer, Denver Metro Area

Cassana Littler - 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

Kyra deGruy Kennedy - Health Care Consumer, Denver Metro Area

Amanda Massey - Health Insurer Representative, Denver Metro Area

Gretchen McGinnis - Health Insurer Representative, Denver Metro Area

Mark Queirolo - Colorado Department of Health Care Policy & Financing

Miranda Ross - Health Insurer Representative, Denver Metro Area

Lisa Rothgery - Health Provider Representative, Denver Metro Area

Kari Snelson - Health Insurer Representative, Northeast Colorado

Jack Teter - Health Care Provider, Denver Metro Area

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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

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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.