Primary Care Payment Reform Collaborative

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

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.

First Annual Recommendations Report (Dec 2019) - Primary Care Payment Reform Collaborative

Recommendations regarding the Use of Telehealth to Support Primary Care Delivery during the COVID-19 Pandemic and Beyond (July 2020) - Primary Care Payment Reform Collaborative

The Collaborative, 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. 

2020 Meetings

2020 Meeting Calendar for Primary Care Payment Reform Collaborative

Until further notice, all Collaborative meetings will be REMOTE ONLY - please register using the links provided below (for each meeting date). 

Dec 7, 2020

Please register for the webinar using the following link: https://attendee.gotowebinar.com/register/1698928392429903632 

Meeting Agenda Coming Soon

Nov 19, 2020

Please register for the webinar using the following link: https://attendee.gotowebinar.com/register/7073643594696597264  

Agenda - 11.19.20

Slide deck - 11.19.20

Nov 2, 2020

Please register for the webinar using the following link: https://attendee.gotowebinar.com/register/5919404875159405072 

Agenda - 11.2.20

Slide deck - 11.2.20

Meeting minutes - 11.2.20

Oct 13, 2020

Please register for the webinar using the following link: https://attendee.gotowebinar.com/register/1121969561359161872

Agenda - 10.13.20

Slide deck - 10.13.20

PCPRC - Priorities Framework

Meeting minutes - 10.13.20

Sept 21, 2020

Please register for the webinar using the following link: https://attendee.gotowebinar.com/register/711116150637346832

Agenda - 9.21.20

Slide deck - 9.21.20

Primary Care APM Issues and Opportunities - DRAFT

Sept. 1, 2020

Please register for the webinar using the following link: https://attendee.gotowebinar.com/register/3809323313919091472 

Agenda - 9.1.20

Slide deck - 9.1.20

Supporting the Critical Role of Primary Care in the COVID-19 Response - Commonwealth, August 18, 2020

After COVID-19, A Payment Policy Reboot: Three Lessons From The Pandemic On How To Improve Value-Based Payment - Health Affairs, August 11, 2020

COVID-19, Market Consolidation, And Price Growth - Health Affairs, August 3, 2020

The Day After Tomorrow Must Include Independent Primary Care - Health Affairs, July 23, 2020

August 10, 2020

Please register for the webinar using the following link: https://attendee.gotowebinar.com/register/6283685171786849291

Agenda - 8.10.20

Slide deck - 8.10.20

DRAFT New Regulation 4-2-7X - Concerning Strategies to Enhance Health Insurance Affordability

Overview of Revised PC-AMP Regulation

Report Recommendations - Draft Regulation Crosswalk

DRAFT Meeting Minutes - 8.10.20

July 7, 2020

Webinar: https://meetingsamer.webex.com/meetingsamer/j.php?MTID=m0d2134a15a8bd6848d39183a30526333; By phone: 1-408-418-9388; Access code: 126 394 2262; Password: PCPRC

Agenda - 7.7.20

Slide deck - 7.7.20

Primary Care Payment Reform Collaborative Telehealth Recommendations - Final Draft for Approval

Meeting minutes - 7.7.20

June 11, 2020

Webinar: https://meetingsamer.webex.com/meetingsamer/j.php?MTID=mab788fb572ae9c9a32545c3f0e9eb173; By phone: 1-408-418-9388; Access code: 126 623 1468; Password: PCPRC

Agenda - 6.11.20

Slide deck - 6.11.20

Meeting minutes - 6.11.20

May 18, 2020

Webinar: https://meetingsamer.webex.com/meetingsamer/j.php?MTID=me7987339eb2a395fd8ea7256f54149ec; By phone: 1-408-418-9388; Access code: 625 923 786​; Password: PCPRC

Agenda - 5.18.20

Slide deck - 5.18.20

Primary Care in CO - COVID-19 and Beyond

How Payment Reform Could Enable Primary Care to Respond to COVID-19  - Updated Milbank Brief, May 2020

Telemedicine in Colorado: The Jetsons, a RAPID Response to COVID-19, and the Big Questions Ahead - Colorado Health Institute Report

Populations at Risk for Serious Illness from COVID-19 - CIVHC analysis

Standard Operating Procedures and Rules of Order - UPDATED 5.18.20

Meeting minutes - 5.18.20

April 29, 2020

Webinar: https://meetingsamer.webex.com/meetingsamer/j.php?MTID=m44e3db5e1dd51f6012d6c3eea52d5029; By phone: 1-408-418-9388; Access code: 626 828 694

Agenda - 4.29.20

Slide deck - 4.29.20

Draft PCPRC Project/Annual Report Planning Tool

Quick COVID-19 Primary Care Survey National Data (Series 5 Fielded April 10-13, 2020) - PCC and Larry A. Green Center

Quick COVID-19 Primary Care Survey Colorado-specific Data (Serries 5 Fileded April 10-13, 2020) - PCC and Larry A. Green Center

Milbank Issue Brief, April 2020- How Payment Reform Could Enable Primary Care to Respond to COVID-19

Health Affairs article, April 17, 2020- The COVID-19 Tsunami: The Tide Goes Out Before It Comes In

Meeting minutes - 4.29.20

March 17, 2020

1560 Broadway, Room 110B, Denver 80202, Dial-in: 720-279-0026, Passcode: 197413

Agenda - 3.17.20

Discussion items re: DRAFT Regulation 4-2-7X

Meeting minutes - 3.17.20

Feb. 27, 2020

1560 Broadway, Room 110B, Denver 80202, Dial-in: 720-279-0026, Passcode: 197413

Agenda - 2.27.20

HCPLAN Alternative Payment Models (APM) Framework

HCPLAN Payment Reform Goals

HCPLAN CMS Payment Model

PCPRC Statement from Co-Chair Nominees

DRAFT Regulation 4-2-7X Concerning Strategies to Enhance Health Insurance Affordability

Meeting minutes - 2.27.20

Feb. 3, 2020

1560 Broadway, Room 110B, Denver 80202, Dial-in: 720-279-0026, Passcode: 197413

Agenda - 2.3.20

Primary Care Investment - Potential Metrics

HCPLAN Alternative Payment Models (APM) Framework

HCPLAN APM Whitepaper

Meeting Minutes - 2.3.20 

Jan. 14, 2020

1560 Broadway, Room 100 C, Denver 80202, Dial-in: 720-279-0026, Passcode: 197413

Agenda - 1.14.20

CIVHC Data Submission Guide - DRAFT Letter

PCPRC Process Recommendations for 2020

Colorado PCPRC Standard Operating Procedures and Rules of Order

Meeting Minutes - 1.14.20

2019 Meetings

Dec. 12, 2019

1560 Broadway, Room 110D, Denver 80202, Dial-in: 720-279-0026, Passcode: 197413

Agenda

PCPRC Recommendations Report - Final Version for PCPRC Review

Revisions Guide for Final Draft

Dec. 2 2019

1560 Broadway, Room 110D, Denver 80202, Dial-in: 720-279-0026, Passcode: 197413

Agenda

Draft PCPRC Report Review Matrix

Colorado PCPRC Recommendations Report for Dec. 15, 2019 - DRAFT

CIVHC Report of Primary Care Spending Based on Carrier-Submitted APM Data -DRAFT 11-15-19 with Addendum

Colorado PCPRC Standard Operative Procedures and Rules of Order - FINAL

Nov. 12, 2019

Colorado Health Institute, 303 E. 17th Avenue, Suite 930, Denver; Dial-in: 720-279-0026, Passcode: 197413

Agenda

PCPRC Primary Care Investment Targets - Discussion Summary

PC Investment and Affordability

Oct. 22, 2019

1560 Broadway, Room 110D, Denver 80202; Dial-in: 720-279-0026, Passcode: 197413

Agenda

Primary Care Investment - National and State Analyses

Primary Care Investment Targets - Other States

Primary Care Spending in the Fee-for-Service Medicare Population

Standardizing the Measurement of Commercial Health Plan Primary Care Spending

Sept. 30, 2019

1560 Broadway, Room 110D, Denver 80202; Dial-in: 720-279-0026, Passcode: 197413

Investing in Primary Care: A state-level analysis (July 2019) - from the Patient-Centered Primary Care Collaborative

2019 Colorado Health Access Survey (CHAS): Progress in Peril - from the Colorado Health Institute

Sept. 10, 2019

1560 Broadway, Room 100B, Denver 80202; Dial-in: 720-279-0026, Passcode: 197413

Agenda

Alternative Payment Models and Primary Care presentation

CIVHC Primary Care Spending Report for DOI 8-27-19

Defining Primary Care

Defining Primary Care - Tracked Changes

How evolving US payment models impact primary care quality

Aug. 19, 2019

1560 Broadway, Room 110D, Denver, 80202; Dial-in: 720-279-0026, Passcode: 197413

Agenda

Rules of Order and Standard Operating Procedures - Primary Care Collaborative

The Importance Of Primary Care—And Of Measuring It - Health Affairs, Aug. 6, 2019

DRAFT - Defining Primary Care - as of 8-12-19

Colorado Assoc. of Health Plans Presentation - Carrier reimbursement practices in primary care

July 31, 2019

1560 Broadway, Room 110D, Denver, 80202; Dial In: 720-279-0026, Passcode: 197413

Agenda

Rhode Island Primary Care Experiment - Health Affairs May 2010

What has been done elsewhere - Primary Care

Definitions of Primary Care 6.1.19

CIVHC Alternative Payment Model and Primary Care Definitions Presentation

Primary Care Definition Codes

Revised Share of Primary Care Spend Report III

Primary Care Summary Spending Graphs III

July 8, 2019

1560 Broadway, Room 110D, Denver, 80202; Dial In: 720-279-0026, Passcode: 197413

Agenda

Rhode Island Spending Slowed - Health Affairs Feb. 2019

HB19-1233 Timeline and Responsibilities

Members

Collaborative Members

Jimmy Burds - Employer Representative, Denver Metro area

Laura Coleman - CMS / Consortium for Medicare Health Plans Operatios

Isabel Cruz - Health Care Consumer, Denver Metro area

Amy Dickson - Primary Care Provider, Denver / Mountain Communities

Stephanie Gold - Primary Care Provider, Denver Metro area

Patrick Gordon - Health Insurer Representative, Western Slope

Steve Holloway - Colorado Department of Public Health & Environment

Tracy Johnson - Colorado Department of Health Care Policy & Financing

David Keller - Primary Care Provider , Denver Metro area

Kyra deGruy Kennedy - Health Care Consumer, Denver Metro Area

Greg McCarthy - Health Insurer Representative, 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

R. Holbrook Stapp - Primary Care Provider, Denver Metro area

Alwin Steinmann - Primary Care Provider, Denver Metro area

Stacy Stein - Health Care Consumer, Western Slope & Mountain Communities

Andrea Stojsavljevic - Health Care Consumer, Denver Metro area

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

Christina Yebuah - Health Care Consumer, Denver Metro area

 

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.

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