Primary Care Payment Reform

Alternative Payment Model for Primary Care

The Alternative Payment Model for Primary Care (APM) is part of the Department’s efforts to shift from paying for volume to paying for value across the entire delivery system. The APM is designed to support primary care providers through this shift. The Department, in close collaboration with stakeholders, has developed three goals for the APM:

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

Under the APM, the Department will adjust payments to primary care providers based on the providers’ performance. Progress within this framework not only encourages higher organizational performance but also helps the Accountable Care Collaborative (ACC) achieve its programmatic goals.

News: The measure selection survey for APM Performance Year 2020 is now open! Practices must select measures for the next year by December 31, 2019. Select your measures by clicking the button below:

How does the APM work within the Accountable Care Collaborative?

The Accountable Care Collaborative (ACC) is the core of the state’s Medicaid program. It promotes improved health for members by delivering care in an increasingly seamless way. The ACC provides the framework in which other health care initiatives, such as payment reform, can thrive. The APM applies to practices that are designated as Primary Care Medical Providers (PCMPs) under the ACC, including Federally Qualified Health Centers (FQHC).

To be eligible to participate in the APM, a PCMP must also:

  • Serve at least 200 ACC enrollees, or
  • Receive at least $30,000 in historical annual paid claims associated with the APM Code Set

All FQHCs in Colorado are eligible to participate in the APM.

PCMPs who are eligible to participate in the APM but choose not to do so will see a decrease in reimbursement rates. Providers who are not contracted as PCMPs in the ACC are not able to opt-in to the APM.

To learn more about eligibility requirements and other aspects of the APM, please read the Primary Care Alternative Payment Model Guidebook available in the Resources to Get Started section below.