Alternative Payment Model 2 (APM 2) Overview
Participating practices can choose to receive some or all of their revenue as Per Member Per Month payments, to provide stable revenue and allow for increased investment in care improvement. Participating providers are also eligible to share in the savings that result from improved chronic care management by meeting quality thresholds. This model was designed with input from stakeholders across Colorado to prioritize excellent primary care for members with chronic conditions, improving member outcomes and reducing health disparities. Primary Care Providers have the option of using a value-based payment model when caring for Health First Colorado members. That means the power is back in each provider’s hands to make the best decisions for their patients to support quality outcomes and healthier patients. Freed from utilization as the driving factor for revenue, providers can consistently make the decisions they want for their patients, ensuring the best possible care.
APM 2 Informational Webinars
The Department held two informational webinars in early 2023 to review the Alternative Payment Model 2 program.
February 14th, 2023
January 25th, 2023
What are some of the benefits of enrolling in APM 2?
- Providers can create the revenue stability they need by switching to this Medicaid reimbursement model that encourages quality outcomes and the best health possible for each Health First Colorado member.
- Providers have the flexibility to choose to have a portion or all of their revenue made as per member per month payments creating a reliable revenue stream that can weather tough challenges like the pandemic and more normal fluctuations as well.
- Providers can select the way they want to receive their payments, so they have an onramp to participation. Providers can decide how far and how fast they join the program and have the option to change their level of participation over time.
- Providers who join can share in savings from improved primary and chronic care outcomes as well as benefit from lower administrative burden. Providers only need to meet set quality thresholds to share in the cost savings of leaving the old utilization-based system and converting to a more provider and patient-friendly value-based system.
- A full conversion to value-based payments is the future of Health First Colorado. Enrolling now will allow providers to get greater support as they transition and have a voice in the final structure of the program.
- Providers already participating in the Alternative Payment Model 1 program and meeting those quality standards will find that joining APM 2 involves the same standards but adds important control over payments that provide stability to their revenue stream and potential additional revenue through a share in cost savings through better management of chronic care.
Who is eligible to participate now?
All APM 1 enrolled practices are eligible. To learn more about APM 1 eligibility visit the program webpage. Practices with fewer than 500 Medicaid patients may be considered for APM 2 on a case by case basis. We encourage any interested practice to email HCPF_primarycarepaymentreform@state.co.us for more information.
How can my organization get started?
To begin the process, providers can request and receive their data calculated by actuaries to reflect their current practice experience. They can use this data to determine the structure of their payments and can request this data for free with no commitment to join.
Reach out to get your free, no-commitment APM 2 Data
- Why APM 2: A high-level guide for providers and practices hoping to learn more
- APM 2 Data Overview: A basic guide for understanding how to decide if APM2 makes financial sense for your practice
- APM 2 Frequently Asked Questions: Regularly updated answers to providers’ most common questions
- APM 2 Advocates Guide: Help for advocates supporting providers and practices as they evaluate program their enrollment decisions
- APM 2 Rate Increase Summary: An overview of the Department's approved budget request for APM 2
- APM 2 Guide Book: A more comprehensive guide for program ins and outs
- APM 2 Primary Care Taxonomy: A complete list of APM2 taxonomy codes
- APM 2 Chronic Condition Risk Adjustment A description of the methodology used to calculate the APM 2 Chronic Condition risk adjustment
Get a quick rundown on the most important points of APM 2 participation
At just 7 minutes apiece, these two videos can help you better understand the program and whether or not it might be right for your practice or organization.
- APM 2 101: This video provides an overview of the program, how it works and why providers across the state are using it to focus on health outcomes for the people they serve.
- APM 2 The Math: This video walks you through provider reimbursements, options for revenue sharing from cost savings and what commitment-free, customized data you can receive with your practice’s own historic numbers
APM 2 for Federally Qualified Health Centers (FQHCs)
Federally Qualified Health Centers are able to sign up for their own track of APM 2. A few key differences of APM 2 FQHC:
- The Per Member Per Month payments represent 100% of medical revenue for FQHCs.
- FQHCs may enroll in the Chronic Condition Incentive Payment separately from the PMPM. The episodes of care are the same for both FQHCs and non-FQHCs.
- Because enrollment occurs at the entity level in this track, FQHCs do not need to meet the threshold of 500 or more attributed Health First Colorado ACC enrollees.
Chronic Condition Episodes included in APM 2
- Arrhythmia/ Heart block - Low
- Crohn’s Disease
- Chronic Obstructive Pulmonary Disease
- Coronary Artery Disease
- Heart Failure
- Gastro-Esophageal Reflux Disease
- Low back pain
- Ulcerative Colitis
The quality measures for APM 2 are the same as those used for APM 1. For more information on the quality measures please refer to the APM 1 Guidebook. PCMPs must earn at least 200 points to be eligible for the incentive payment in the APM 2 program for reducing costs among the 12 chronic conditions.
Email HCPF_primarycarepaymentreform@state.co.us for more information about the program.