Primary Care Payment Reform

Join HCPF to Discuss Primary Care Payment Reform

The Alternative Payment Model for Primary Care (APM) is part of the Department of Health Care Policy & Financing’s efforts to shift from paying for volume to paying for value across the entire delivery system. Under the framework of the Accountable Care Collaborative, the APM contributes to promoting improved health for Health First Colorado members.


The Department is recruiting people to join the APM Refresh Team to inform changes to the APM 2022 Program Year. 


The APM Refresh Team will convene on the following Thursdays at 7:30 a.m. throughout 2021: May 6, May 27, June 17, August 19, September 9, and September 30. All meetings will be held virtually. Here is a link for more information on participating.


We want to hear from health care providers, organizations, and stakeholders across the state! To be considered for the APM Refresh Team, please complete this form by Friday, April 23. Membership is limited. 
 

APM 2021 Program Year Measure Selection Update

Measure selection for the APM 2021 Program Year began Nov. 20. At that time, eligible primary care medical providers (PCMPs) received a communication with the measures menu and a Google form to select and submit their 2021 Program Year measures. The PCMPs also received refreshed claims data reports to reference when selecting actionable measures for the 2021 Program Year.

Earlier this fall, stakeholders partnered with the Department of Health Care Policy and Financing to design the APM 2021 Program Year. See the Stakeholder Recommendations Memo for more information. Measure selection for the 2021 Program Year closes Dec. 31. The measures selected will be final for the 2021 Program Year. PCMPs should also request access to the Colorado Data Analytics Portal. Portal access is important because it will be the resource providers use to access and evaluate performance reports in 2021. PCMPs should connect with their Regional Accountable Entity (RAE) to request portal access.

Previous Updates

2020 Updates


Alternative Payment Model for Primary Care

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.


How does the APM work within the Accountable Care Collaborative?

The Accountable Care Collaborative (ACC) is the core of the state's Medicaid program. It promotes improved health for members by delivering care in an increasingly seamless way. The ACC provides the framework in which other health care initiatives, such as payment reform, can thrive. The APM applies to practices that are designated as Primary Care Medical Providers (PCMPs) under the ACC, including Federally Qualified Health Centers (FQHC).

To be eligible to participate in the APM, a PCMP must also:

  • Serve at least 200 ACC enrollees, or
  • Receive at least $30,000 in historical annual paid claims associated with the APM Code Set

All FQHCs in Colorado are eligible to participate in the APM.

PCMPs who are eligible to participate in the APM but choose not to do so will see a decrease in reimbursement rates. Providers who are not contracted as PCMPs in the ACC are not able to opt-in to the APM.

To learn more about eligibility requirements and other aspects of the APM, please read the Primary Care Alternative Payment Model Guidebook available in the Resources to Get Started section below.

History

The Department engaged a broad range of stakeholders in 2020to recommend changes and updates to the 2021APM measure set, measure points and measure goals. Stakeholder engagement included focus group meetings, a request for written feedback, meetings with Federally Qualified Health Centers (FQHCs), review with the ACC Program Improvement Advisory Committee (PIAC) and ad hoc workgroup meetings. Click on the link below to view stakeholder feedback and recommendations for the 2021APM measure set, points, and goals.

For information on past webinars recordings and all past workgroups, please email HCPF_primarycarepaymentreform@state.co.us
You can also find the stakeholder engagement webinar recordings listed in the Previous 2020 Updates archive.

Stakeholder Engagement

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, request for written feedback, meetings with providers, and review with the ACC Program Improvement Advisory Committee (PIAC). Click on the link below to view stakeholder feedback and recommendations by program year.

Memorandum of Final Stakeholder Recommendations for APM PY2020

Memorandum of Final Stakeholder Recommendations for APM PY2021

2020 Program Year Documents

2020 Measure Specifications

 

Program Participation Resources To Get Started

Measure Set
 
 
2021 Claims Measure Specifications
eCQMS Measure Specifications
 

eCQM Number, Specifications and Description

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 74- Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists

CMS 82- Maternal Depression Screening

CMS 117- Childhood Immunization Status

CMS 122- Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>,9%)

CMS 125- Breast Cancer Screening

CMS 130- Colorectal Cancer Screening

CMS 131- Diabetes: Eye Exam

CMS 138- Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

CMS 153- Chlamydia Screening for Women

CMS 155- Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents

CMS 161- Adult Major Depressive Disorder (MDD): Suicide Risk Assessment

CMS 165- Controlling High Blood Pressure

CMS 177- Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment

 

Measure Set Master List

 
 
 
Contact Information

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