Medicaid APM: Next steps for SIM practices

The alternative payment model (APM) introduced by The Colorado Department of Health Care Policy and Financing (HCPF) provides a prime example of how SIM has prepared providers for success with reimbursement that rewards the value (instead of volume) of health care delivered.

“SIM was a catalyst for us to think about payment reform in Colorado,” said Shane Mofford, director of rates and payment reform for HCPF, during the last SIM-funded Multi-Stakeholder Symposium in June. “Those who are participating in SIM and in CPC+ are doing what it takes to really advance the delivery system and we’ve acknowledged that by giving the providers credit in our payment models the first performance year.”

While practices participating in SIM and the Comprehensive Primary Care Plus (CPC+) initiatives were not required to select measures for this APM for the 2019 performance year, SIM-participating practices must select 10 measures for the second performance year (2020) before Dec. 31. Practices participating in CPC+ get an additional year of credit in the APM model without the need to select measures this year.

As background, only primary care medical providers who reach the $30,000-Medicaid billing threshold are eligible for this APM. Get more details in the Primary Care Alternative Payment Model Survival Guide, which includes an APM measure point estimator with all measures as well as a full explanation of goals and timeline. A FAQ resource is also available with helpful tips and information.

Use of electronic clinical quality measures (eCQM) is cited frequently by the HCPF team as a key component for success with the APM and the SIM-funded eCQM solution can be used for practices to report measures. Stay tuned for more information about this from HCPF and the Office of eHealth Information (OeHI), which is assuming oversight of the tool after SIM ends July 31. This foundational work directly aligns with Colorado's Health IT Roadmap, which was steered by Colorado's eHealth Commission. 

HCPF representatives will reach out to practices to provide clarity on the process of selecting measures and to field questions about the measure selection survey. Technical questions about measure selection should be directed to designated regional accountable entities (, organizations that can help practices select measures that account for client panels and communities and align with other initiatives. This foundational work directly aligns with Colorado's Health IT Roadmap, which was steered by the state’s eHealth Commission.

Mofford encouraged practice teams to pick the measures they were working on in SIM. “The things you’ve done [in SIM] will set you up for success with this [APM],” he said. “I think participation in these models has really teed everyone up for success.” Listen to his short presentation during the Multi-Stakeholder Symposium.