Primary Care Payment Reform

Primary Care Payment Is Changing

As part of the Department’s efforts to shift providers from volume to value, the Department, along with stakeholders, has developed a payment model to make differential fee-for-service payments based on the provider’s performance. This payment model aims to give providers greater flexibility in care provided, reward performance, and maintain transparency and accountability in payments made. Under the proposed model, providers can earn higher reimbursement when designated as meeting specific criteria or performing on quality metrics. Progress within this framework not only encourages higher organizational performance but also helps the Accountable Care Collaborative (ACC) achieve its respective programmatic goals. 

  The Department is adjusting the implementation of the Alternative Payment Model (APM) for participating practices. 

  • The 2019 performance year will be evaluated and incentive payments will be issued based on each practice’s reporting only. This means that every practice that selects measures and properly reports progress on those measures will receive incentive payments.  
  • Claims data will be available to practices in early 2019. This data will help practices understand where they stand for the 2019 performance year and begin to think about measure selection for the 2020 performance year.  

 These implementation adjustments are intended to assist practices in fully incorporating the APM into their business processes. The Department is committed to partnering with practices and ensuring all participating practices are successful in APM implementation. Practices should still select APM   measures in November and December 2018 in order to properly report progress or challenge areas identified during the 2019 performance year.

 Measure Selection Survey 

 

APM Goal
  1.   Provide long-term, sustainable investments into primary care; 
  2.   Reward performance and introduce accountability for outcomes and access to care while granting flexibility of choice to PCMPs, and; 
  3.   Align with other payment reforms across the delivery system.

 

APM Eligibility Criteria

  The APM applies to providers designated as a PCMP in the ACC. To be designated as a PCMP, a provider must meet the following requirements:

  • Be a medical practitioner with a focus on primary care (family medicine, internal medicine, pediatrics, geriatrics, obstetrics or gynecology).
  • Enrolled as a Health First Colorado (Colorado’s Medicaid) provider.
  • Licensed and able to practice in the State of Colorado.
  • Holds an MD, DO, or NP provider license.
  • Licensed as one of the following specialties: pediatrics, internal medicine, family medicine, obstetrics, and gynecology, or geriatrics.
  • Community mental health centers and HIV/infectious disease practitioners may qualify as PCMPs if all PCMP criteria are met and with approval from their RAE.

Primary Care Alternative Payment Model Measure Survey

The initial measure selection survey for the 2019 performance year is closed. The Department will be sending confirmation emails to the contacts provided in the survey. Beginning in May 2018 the Department will begin communications with practices about meeting the $30,000 threshold and in late summer 2018 will begin providing data back to practices on all claims-based measures. Practices will have the option to change the measures they selected for 2019 towards the end of 2018. If you have questions regarding the Primary Care APM please see the resources below or email: HCPF_primarycarepaymentreform@hcpf.state.co.us 

If you are looking for information on Federally Qualified Health Centers (FQHC) please go to this page Federally Qualified Health Center Payment Reform

 
 

Reasonable accommodations for the meetings will be provided upon request for persons with disabilities.  Please contact HCPF_primarycarepaymentreform@hcpf.state.co.us at least one week prior to the scheduled meeting if you need special arrangements.