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, are developing a payment model to make differential fee-for-service payments based on 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 ACC achieve its respective programmatic goals.  
In developing the proposed framework, the Department strives to create a single Health First Colorado primary care payment model that aligns with other state and national initiatives such as the Comprehensive Primary Care Initiative, Comprehensive Primary Care Plus, Enhanced Primary Care Medical Provider incentive program, Medicare Access and CHIP Reauthorization Act of 2015, and SIM, as well as with NCQA standards for Patient-Centered Medical Homes.  
Stakeholders were engaged in the design of every aspect of the alternative payment methodologies and continue to be engaged during the implementation of the APM. 

The Department of Health Care Policy & Financing conducted two live webinars to talk about the coming Alternative Payment Model (APM). See below for previous recordings:

Federally Qualified Health Centers (FQHC) Reforms. Similar to, and aligned with, the primary care payment reforms described above, the Department is engaged in payment reforms with FQHCs to improve access to high quality care by offering alternative payment methodologies that are designed to increase provider flexibility in delivering care while holding providers accountable for client outcomes. 
One of the alternative payment methodologies the Department is developing will put a portion of the FQHC encounter rate at-risk based on performance, to give providers greater flexibility, reward performance while maintaining transparency and accountability, and create alignment across the delivery system. 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 ACC achieve its respective programmatic goals. If you have questions about the FQHC APM please contact Marija Weeden at marija@cchn.org

 

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 

 

 
 

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.