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).
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 advises the DOI in the development of affordability standards and targets for health insurance company investments in primary care. Created through House Bill 19-1233 and convened by the DOI, part of the Department of Regulatory Agencies (DORA), the Collaborative has been meeting since July of 2019 to develop recommendations aimed at increasing investments in high-quality primary care.
In addition to focusing on the development of strategies for increased investments in primary care, the Collaborative advances 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.
2025 Meetings
2025 Meeting Schedule 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 2025 using the following link:
Register for 2025 Collaborative Meetings
- July 2025 - SUMMER BREAK (NO MEETING)
Members please enjoy your summer break!
- June 12, 2025
People Demand Better Primary Care - Fact Sheet - United States of Care, March 2025
Natalie Davis on Why You Shouldn't Talk about Value-Based Care - The ACO Show, 5.19.25
Strengthening Primary Care by Meeting People's Needs - Commonwealth Fund, 3.5.25
The General Public Vastly Overestimates Primary Care Spending in the United States - Annals of Family Medicine, March-April 2025
Letting Patients Lead the Way to More Effective Value-Based Payment - Health Affairs, 3.24.25
- May 8, 2025
Draft meeting minutes - 5.8.25
Reflecting on 2 Decades of Medicare ACO Experience - JAMA, 4.28.25
Year 1 of Medicare’s Accountable Care Organization Realizing Equity, Access, and Community Health Model - JAMA, 4.25.25
The Value Zeitgeist - Considering the Slowdown in Health Care Spending Growth - NEJM, 4.17.25
Changes in Primary Care Practice Setting and Practice Type for Medicare Beneficiaries - JAMA 4.25.25
“All I Do Is Win”: Why Beating Benchmarks Doesn’t Mean That ACOs Are Reducing Costs - Health Affairs, 4.15.25
- April 10, 2025
DRAFT meeting minutes - 4.10.25
Recent Events Have Made Primary Care More Fragile—Further Challenges Lie Ahead - Health Affairs, 3.4.25
From Laggard To Leader: Why Health Care In The United States Is Failing, And How To Fix It - Health Affairs, 1.22.25
The Health of US Primary Care: 2025 Scorecard Report — The Cost of Neglect - Milbank Memorial Fund, 2.18.25
Report from the Frontlines of US Primary Care on the Impact of Recent Federal Policy Changes - Milbank, 3.27.25
Can Prevention Save Money - JAMA Health Forum 4.3.25
- March 13, 2025
CANCELLED
- February 6, 2025
- January 9, 2025
- December 12, 2024
DRAFT meeting minutes - 12.12.24
DRAFT 2024 Annual Report - v 12.6.24
Primary Care and APM Model Use in Colorado, 2021-2023 Report
Primary Care and APM Model Use in Colorado, 2021-2023 Data Tables
- November 14, 2024
Is It Possible to Pay For More Equitable Outcomes? - Health Affairs, Nov 2024
How Oregon's Merger Review Law Combats Consolidation and What Other States Can Learn From It - Center on Health Insurance Reforms, Georgetown University, 9.30.24
The Elephant(s) in the Room: Lessons from Over a Decade of State Policy to Create a More Primary Care Oriented Delivery System - presentation by Chris Koller at Revitalizing Primary Care Symposium
WORKING DRAFTS:
- October 10, 2024
DRAFT meeting minutes - 10.10.24
Avoiding Financial Toxicity for Patients from Clinicians’ Use of AI - NEJM 10.3.24
That Message From Your Doctor? It May Have Been Drafted by A.I. - NYT 9.24.24
Accounting for Children in Accountable Care Organizations - JAMA Pediatrics 9.30.24
Expanding Permanent Pathways In Medicare For Accountable Care - Health Affairs 9.30.24
How To Evaluate The Innovation Center’s Impact On Delivery System Transformation - Health Affairs 9.24.24
How the CMS Innovation Center is Supporting Primary Care - CMMI 5.14.24
- September 12, 2024
Payer Strategies for Advancing Health Equity through Value-Based Payment - Health Care Transformation Task Force, August 2024
Assessing Equity to Drive Health Care Improvements: Learnings from CMMI - CMS, July 2023
REACHing for Equity - Moving from Regressive toward Progressive Value-Based Payment - NEJM, July 2022
Value-Based Payment and Vanishing Small Independent Practices - JAMA, Aug 2024
The Failing Experiment of Primary Care as a For-Profit Enterprise - Health Affairs, Sept 2024
- August 8, 2024
Characterizing the Clinical Adoption of Medical AI Devices through US Insurance Claims- NEJM 7.9.23
- July 11, 2024
How Should Medicare Pay for Artificial Intelligence? JAMA Internal Medicine 5.28.24
Using Artificial Intelligence to Improve Primary Care for Patients and Clinicians - JAMA Internal Medicine April 2024
An Overarching Framework for the Ethics of Artificial Intelligence in Pediatrics - JAMA Pediatrics March 2024
Navigating the doctor-patient-AI relationship - a mixed-methods study of physician attitudes toward artificial intelligence in primary care - BMC Primary Care 2024
Medical Artificial Intelligence and Human Values - New England Journal of Medicine - 5.30.24
Artificial intelligence and health inequities in primary care: a systematic scoping review and framework - Family Medicine and Community Health 2022
Artificial Intelligence-Generated Draft Replies to Patient Inbox Messages - JAMA Open Network 3.20.24
- June 13, 2024
* * * MEETING CANCELLED * * *
- May 9, 2024
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
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
Health of US Primary Care - 2024 Scorecard Report- Milbank Memorial Fund and Physicians Foundation - Feb 2024
- February 8, 2024
- January 11, 2024
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 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
Josh Benn - Colorado Department of Personnel and Administration
Isabel Cruz - Health Care Consumer, Denver Metro Area
Britta Fuglevand - Colorado Department of Health Care Policy & Financing
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
Alexandra Hulst - Health Care Provider, Western Slope
Rajendra Kadari - Health Care Provider, Denver Metro Area
Cassana Littler - Primary Care Provider, Denver Metro Area
Amanda Massey - Health Insurer, Denver Metro Area
Kevin McFatridge - Health Insurer, Denver Metro Area
Amy Scanlan - Health Care Provider, Denver Metro Area
Gretchen Stasica - Health Insurer, Denver Metro Area
Kevin Stansbury - Health Care Provider, Eastern Slope
Jack Teter - Health Care Provider, Denver Metro Area
Annual Recommendation 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:
- Sixth Annual Recommendations Report - February 2025 - Primary Care Payment Reform Collaborative
- Fifth Annual Recommendations Report - February 2024 - Primary Care Payment Reform Collaborative
- Fourth Annual Recommendations Report - February 2023 - Primary Care Payment Reform Collaborative
- Third Annual Recommendations Report - December 2021 - Primary Care Payment Reform Collaborative
- Second Annual Recommendations Report - December 2020 - Primary Care Payment Reform Collaborative
- First Annual Recommendations Report - December 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
Multi-Payer Alignment
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
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
December 12, 2024
For more information about the Collaborative, contact Tara Smith, Primary Care and Affordability Director - tara.smith@state.co.us; 720-701-0081.