Alternative Payment Model 2 (APM 2) Overview
This program is a continuation of the efforts informing the original Alternative Payment Model (APM) program that is ongoing, and automatic for eligible providers. This program adheres to the goal of creating stable investments in primary care to help support and incentivize innovative care delivery. It focuses on chronic conditions, which compose a common, but complicated set of health concerns addressed in a primary care setting.
There are a few differences in the program design compared to the original APM program. Most providers who meet the eligibility requirements of the original APM program will also be eligible to participate in APM 2. Primary Care Medical Providers (PCMPs) only have to meet the $30,000 billing threshold for a modified APM code set, we are no longer requiring a minimum member volume of 200 ACC enrollees to be eligible for this program. FQHCs are not eligible to participate in APM 2. PCMPs who are eligible but elect not to participate in APM 2 will not see a change in their reimbursement rates as a result of opting-out. Providers who are not currently contracted as PCMPs are not eligible to participate in this program.
Check back soon for the Primary Care Alternative Payment Model 2 Guidebook, which will provide more details of the program. Once published, it will be available under the “Resources” section below.
History and Development
The Department developed a goal of shifting health care service reimbursement from volume-based payments to value-based payments, and the original APM program was the first step towards realizing this goal. APM 2 seeks to continue those efforts and expand their scope to realize the biggest impact possible from these value-based payment models. This furthers the core goals outlined in the Accountable Care Collaborative (ACC) of improving health outcomes for Health First Colorado members, as well as saving money. As the ACC moves into the next phase, this new payment model will help maintain that forward momentum and continue the progress made with the existing value-based payment models.
This model was designed in close coordination with a broad array of stakeholders, beginning in early 2021. These meetings informed the model design, including the conditions of focus and the program goals. These engagements included listening sessions with providers, advocates, and Health First Colorado members, as well as seven model design team meetings over which the model was developed and refined.