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.

Recommendations Report 12/15/19 - 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 - access information will be provided prior to each meeting. 

2019 Meetings

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:

• Reduces 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.
• 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 the first year (July 2019-June 2020).

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