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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:
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:
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:
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.
The Department engaged a broad range of stakeholders in 2019 to recommend changes and updates to the 2020 APM measure set, measure points and measure goals. Stakeholder engagement included focus group meetings, a request for written feedback, meetings with Federally Qualified Health Centers (FQHCs), review with the ACC Program Improvement Advisory Committee (PIAC) and ad hoc workgroup meetings. Click on the link below to view stakeholder feedback and recommendations for the 2020 APM measure set, points, and goals.
Memorandum of Final Stakeholder Recommendations for 2020 APM
For information on past webinars recordings and all past workgroups, please email HCPF_primarycarepaymentreform@hcpf.state.co.us
2018/19 Survival Guide
2019 Structural Measures
2019 Full Measure List
eCQM Number, Specifications & Description
CMS 2 - Preventive Care and Screening: Screening for Depression and Follow-Up Plan
CMS 69 - Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
CMS 74 - Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists
CMS 82 - Maternal Depression Screening
CMS 117 - Childhood Immunization Status
CMS 122 - Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
CMS 125 - Breast Cancer Screening
CMS 130 - Colorectal Cancer Screening
CMS 131 - Diabetes: Eye Exam
CMS 138 - Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
CMS 153 - Chlamydia Screening for Women
CMS 155 - Weight Assessment and Counseling for Nutrition & Physical Activity for Children & Adolescents
CMS 161 - Adult Major Depressive Disorder (MDD): Suicide Risk Assessment
CMS 165 - Controlling High Blood Pressure
CMS 177 - Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment
For information concerning the Primary Care Payment Reform meetings please contact: