Prescriber Tool Alternative Payment Model

Prescriber Tool Alternative Payment Model Overview

The Prescriber Tool Alternative Payment Model (APM) is an upside-risk-only program designed to incentivize increased and consistent use of the Prescriber Tool, specifically the Real-Time Benefits Inquiry (RTBI) module, and prescription of preferred medications where clinically appropriate. In the first year of the program, to be eligible for an incentive payment, providers are required to complete a data validation survey and training on the RTBI module. Provider preferred drug list (PDL) compliance rate for a baseline year will be analyzed to determine the amount of the incentive payment.
100% of savings from Prescriber Tool usage will be shared with eligible providers for the first program year, which will conclude June 30, 2024.
The program launched statewide on October 2, 2023. The program opt-out and contact update form is now closed. Results from the form will be used to send out credentials for a Prescriber Tool APM dashboard on January 29, 2024 and to exclude practices that opted out. Opting out of the program means that a dashboard will not be created for the provider, and they will therefore be ineligible to receive an incentive payment through the APM. Providers that opt-out will have the opportunity to opt in during Spring 2024, prior to the start of the next program year. Note, this new deadline is an extension from the original March 31, 2024 deadline.

Note that the proposed program design is subject to change, pending CMS approval.

Dashboard credentials were emailed out to eligible NPIs on January 29, 2024. The dashboards are now live as well. The survey and training required for incentive payment eligibility will be open until April 19, 2024, at which point they will no longer be accessible for the duration of the program year.

Prescriber Tool APM Design

The Prescriber Tool Alternative Payment Model is intended to increase awareness of the RTBI module function as well as corresponding reporting that the Department receives on use of the module. Additionally, it is designed to provide information on the Prescriber Tool capabilities as well as solicit feedback to ensure that the Tool evolves in a way that meets provider needs. 
Feedback from a pilot period from March to April prompted the Department to adjust the program design to better meet the current landscape and program goal. Providers are encouraged to visit the Provider Web Portal to ensure their enrollment is up to date as this can influence performance in the program. The Department encourages providers to update their affiliation in the Provider Web Portal by October 13th, 2023 to ensure accurate attribution when the practice dashboards are released.

Prescriber Tool APM Dashboards

To support providers in this model, dashboards will be created for participating providers. These dashboards will require login credentials, which were distributed via email, along with directions to the dashboard landing page, on January 29, 2024. Access to the dashboards is required to complete the required program activities, so providers should ensure they complete the contact update form, linked above, to ensure those credentials are distributed to the right individual(s). Providers are urged to save the landing page somewhere accessible for easy access to complete the required activities within the activity window. 

The Department has engaged Myers and Stauffer, LC to support the dashboard implementation and operations. They emailed dashboard login credentials to eligible practices on January 29, 2024  and will be sending intermittent reminder emails to complete the survey until April 19, 2024 from the email address corxapm@mslc.com. More information about their support is available in Section V of the Dashboard User Guide, linked below.

Development History

Design for the APM began in late 2021 and has been iterative to reflect the needs of providers. This included adding a year to program development to allow for time to assess functionality of the RTBI module among different EHRs around the state. 

Last year, the Department hosted two sessions for stakeholder engagement around the Prescriber Tool APM design. This was to present the proposed final model design prior to a small pilot of dashboards that related to the program design. The slides and meeting recordings are linked below. Please note that the slides linked below in this section do not reflect the most current design. A pilot for the dashboards was conducted from March to April 2023, which informed program redesign prior to the October launch. 

Past Webinars

The Department hosted two informational sessions about the Prescriber Tool APM design in December 2023. 

Dec 13, 2023

Prescriber Tool Alternative Payment Model (APM) Overview Session #2

Dec 7, 2023

Prescriber Tool Alternative Payment Model (APM) Overview Session #1

Who is eligible to participate?

The Prescriber Tool APM is open to Health First Colorado providers receiving fee-for-service payments for their outpatient pharmaceutical claims. The APM does not have a minimum attributed member size limit. Practices are automatically enrolled in the Prescriber Tool APM but must use a compatible EHR system. Individual prescribers are attributed to billing providers. The practice types to which prescribers can be attributed are included below.

Eligible Provider Types
04 – Dentist26 – Osteopath
05 – Physician32 – FQHC
06 – Podiatrist35 – CMHC
07 – Optometrist41 – Nurse practitioner
16 – Clinic practitioner45 – Rural health clinic
22 – Nurse midwife47 – Clinic – dental
24 – Non-physician practitioner - individual61 – Indian Health Services - FQHC
25 – Non-physician practitioner – group64 – Substance use disorder - clinics

Program Resources

Contact Information

Email hcpf_pharmacyapm@state.co.us for more information about the program.