In early 2019 the State of Colorado passed legislation to set targets for investment in primary care and to establish a state-run primary care payment reform collaborative. In December the Colorado Primary Care Payment Reform Collaborative published its first Primary Care Payment Reform Recommendations Report.
The Collaborative, convened by the Division of Insurance (DOI), has been meeting since July to develop a set of recommendations aimed at increasing investments in high-quality primary care.
“We know that primary care is a critical component of healthcare in Colorado,” said Insurance Commissioner Michael Conway, in a statement. “The Collaborative’s effort has resulted in a report that provides a framework for the Division’s work in advancing primary care moving forward.”
The report offers five key recommendations:
1. An inclusive definition of primary care, which includes a broad range of provider types, including family medicine physicians, general pediatric and adolescent medicine physicians and geriatric medicine.
2. A recommended primary care investment target. After discussion and review of currently available data, the Collaborative is recommending a 1 percentage point increase in primary care spending by commercial insurance companies in 2021 and again in 2022. The Collaborative will work with the Center for Innovation in Health Care (CIVHC) in 2020 to improve the data currently available on primary care spending, and establish a reliable baseline for each payer. After 1 percentage point increases in 2021 and 2022, the Collaborative intends to re-evaluate this target in 2022, to make sure it is leading to better outcomes and more affordable care for all Coloradans.
3. A recommendation to identify and track short-, medium-, and long-term measures that are expected to be improved through increased investment in primary care.
4. A recommendation that increased investments should support primary care providers in adopting evidence-based, advance care delivery models that focus on whole-person care, which is the coordination of health, behavioral health and social services for care that focuses on the patient’s needs.
5. A recommendation that increased investments in primary care should be offered primarily through infrastructure investments and alternative payment models, which focus on quality of care and health outcomes rather than the volume of patients treated.
Colorado has made significant investments in coordinated health information technology (HIT) infrastructure, known as Health Data Colorado (HDCo), to collect and validate electronic clinical quality measures across payers. HDCo supports multi-payer alignment on measures and provides a coordinated source of quality data for policymakers. The state notes that although the system is operational; there is more work to be done to refine the validation processes, to capture additional measure types, and to onboard more practices.
The Collaborative is tasked with delivering a report annually, every Dec. 15, to the Insurance Commissioner with recommendations concerning increased investment in primary care. The Collaborative consists of 22 people from all over the state in all areas of healthcare — primary care physicians, consumers, health insurers, government entities and actuaries.
