Primary Care Payment Reform

Alternative Payment Model 2 (APM 2) - Value Based Payments for Primary Care and Chronic Care Management

The Department of Health Care Policy & Financing has been working to develop a new, voluntary alternative payment model for primary care. This program does not replace the existing Alternative Payment Model (APM) program that many providers automatically participate in.  Alternative Payment Model 2 (APM 2) for more information on this new program. 


Updates

  • Measure selection for APM I Program Year 2022 is now open and the link to the Measure Selection survey can be found at this link  More information on measure selection can be found at the bottom of this page
  • The 2021 stakeholder engagement process has closed for the year. See further down for meeting materials and recordings from stakeholder sessions

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.

As part of this effort to transition to value, the Department has developed a new payment model. This new model, currently named APM 2, is designed to provide stable investments in primary care and incentivize better outcomes for patients with multiple chronic conditions. This program was developed in conjunction with Colorado physicians, advocates, and Medicaid members. See attached flyer for the full program outline and FAQs. 


How does the APM work within the Accountable Care Collaborative? Doctor checking child

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 serve 500 or more attributed ACC enrollees. 

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.

APM I Program Participation Resources To Get Started

Measure Set

 

2022 Administrative Measure Specifications (formerly called Claims Measures)

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.

eCQM 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 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

Public 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, 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.

Memorandum of Final Stakeholder Recommendations for APM PY2022

Memorandum of Final Stakeholder Recommendations for APM PY2021

Memorandum of Final Stakeholder Recommendations for APM PY2020

 

 

2021 Stakeholder Sessions

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.


View Meeting Recording  Access Passcode: B!uuMVG9


Public Listening Session #1:  Wednesday, August 4, 2021, 7:30 – 9:00 a.m.


View Meeting Recording   Access Passcode: 057P3+85


Meeting Materials


The Department of Health Care Policy & Financing also convened a 2021 APM Refresh Team to inform program updates. Meetings began in May 2021 and were open to the public. All meetings have now been completed; please stay tuned for information about meetings in 2022.

Meeting #3: June 17

Meeting #2: May 27

Meeting #1: May 6

Meeting #6 September 30

Meeting #5 September 9

Meeting #4: August 26

Measure Selection (For Providers)

2022 Measure Selection


Measure selection for the APM 2022 Program Year is open from now (November 18) to December 31, 2021. The new 2022 measure selection form can be found on the APM Measure Selection Survey web page. All eligible primary care medical providers (PCMPs) should fill out the form by the due date and refer to any of the above materials when election measures for the program year. 

2021 Measure Selection

Measure selection for the APM 2021 Program Year was open from November 20 to December 31, 2020. 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.
 

PCMPs also need access to the Colorado Data Analytics Portal 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

    Contact Information

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