Alternative Payment Model 1 (APM 1)

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. For an overview of the APM 1 program please watch the APM 101 Webinar

Who Can Participate?

Primary Care Medical Providers (PCMPs) who serve at least 500 attributed ACC enrollees are automatically enrolled in APM 1. Practices may petition HCPF to decline participation if they have insufficient data available to measure quality performance. PCMPs that have less than 500 attributed enrollees may also petition to participate in the program, if they have sufficient data available to measure quality performance. PCMPs who do not participate in APM 1 will not see a change in their reimbursement rates as a result of opting-out.

FQHCs are eligible to participate in APM 1. All FQHCs are automatically enrolled in the program

Upcoming Stakeholder Engagement

The series of upcoming community forums take place in three sessions and cover three distinct topics. You will need to register separately for each session.

Forum #1: Wednesday, October 4, 2023 7:30 – 9:00 a.m.
Topic: APM 1 Lookback and Future
Registration

Forum #2: Wednesday, October 11, 2023 7:30 – 9:00 a.m.
Topic: APM 1 Deep Dive into Quality Reporting
Registration

Forum #3: Thursday, October 19, 7:30 – 9:00 a.m.
Topic: APM 1 Deep Dive into Health Equity
Registration

Meetings are online only. Please register for each of the three sessions to receive details and materials prior to the meetings. All registrants also will receive a link to a recording of an introductory webinar providing background on APM 1 to review before the first session.

The Colorado Health Institute (CHI) will convene and facilitate each meeting. CHI is accepting written feedback or questions in advance at focusgroups@coloradohealthinstitute.org

Program Resources

2023 APM 1 Guidebook

2023 APM Annual Updates Appendix to Guidebook

2023 Alternative Payment Model Code Set

2023 APM 1 Measure Selection Workbook

Quality Measures

2023 Measure Set Master List

2023 Structural Measure Specifications

Accessing Administrative Measure Specifications

Administrative Measure Specifications (formerly called Claims Measures)

Comprehensive Diabetes Care: Hemoglobin (HbA1c) Testing
Lead Screening
For all other administrative measures, please visit the 2021 Technical Specifications Resource Manual for measure specifications, and the Value Set Directory for measure codes, as published by the Centers for Medicare and Medicaid Services. Note that to access the Technical Specifications Resource Manual, you must accept the license agreement.
Adult Measures
Child Measures

eCQM Measure Specifications:

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 117 Childhood Immunization Status
CMS 122 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>,9%)
CMS 124 Cervical Cancer Screening
CMS 125 Breast Cancer Screening
CMS 128 Antidepressant Medication Management
CMS 130 Colorectal Cancer Screening
CMS 153 Chlamydia Screening for Women
CMS 155 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
CMS 165 Controlling High Blood Pressure

Development History

HCPF convened a workgroup of primary care physicians, primary care practice coordinators, office managers, and other key stakeholders to design the APM in Fall 2016. This workgroup had input on almost every aspect of the APM, including quality measures and the payment structure. In collaboration with stakeholders, HCPF identified the following goals for the APM:
1. Provide long-term, sustainable investments in 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.
HCPF continues to conduct an annual stakeholder engagement process to inform updates to the model for each program year. This includes a series of public and workgroup meetings to solicit feedback on the APM such as updates to the measure set, point assignments, and goals for each measure as well as to ensure the APM model continues to achieve its goals.

To prepare for each program year, the Department engages a broad range of stakeholders to recommend changes and updates to the APM measure set, measure points, and measure goals. This stakeholder engagement process may include public listening sessions, ad hoc workgroup meetings, requests for written feedback, meetings with providers, and review by the ACC Program Improvement Advisory Committee (PIAC). Click on the link below to view stakeholder feedback and recommendations by program year.

The Department of Health Care Policy & Financing hosted two public listening sessions to provide updates on the APM program and solicit feedback from stakeholders to inform changes for 2022.
Public Listening Session #2: Tuesday, August 10, 2021, 5:00 – 6:30 p.m.