Colorado Primary Care Group Calls for Increased APM Investments

A new report from the Colorado Primary Care Payment Reform Collaborative calls for a greater focus on alternative payment models (APMs) and infrastructure investments. A key recommendation is that all commercial payers in Colorado should offer at least one APM that includes prospective payments for advanced primary care delivery by 2023.

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. The Collaborative is tasked with delivering a report annually, every Dec. 15, to the Insurance Commissioner with recommendations concerning increased investment in primary care. In December 2021 the Colorado Primary Care Payment Reform Collaborative published its third annual Primary Care Payment Reform Recommendations Report.

The Collaborative’s report notes that most commercial payers operating in Colorado offer some kind of value-based payments, such as care coordination and practice transformation per-member per-month payments, shared savings payments, and incentive payments for completing process measures or meeting quality metrics. “However, not all payers offer an APM that includes prospective payments for advanced primary care delivery. The Collaborative recognizes that payers do not typically require all providers to participate in specific APMs.

The Collaborative notes that effective APMs support the ultimate goal of increasing the number of Coloradans who receive the right care in the right place at the right time at an affordable cost. “The percentage of covered lives receiving care under an APM is an important measure of progress toward the adoption of APMs. While total dollar amounts spent through APMs provide important business-centered insights, the percentage of lives covered through an APM provides a person- centered view. The Collaborative acknowledges the additional cost and reporting effort required from payers to track this information and emphasizes the importance of tracking progress toward both business- and person-centered goals to better understand the full impact of APM adoption.”

The Collaborative recommends a phased approach to collecting and analyzing these data:

• Starting in 2023, payers should include the percentage of covered lives receiving care under APMs in annual implementation plans submitted to the Department of Insurance; and,

• The state should consider implementing a target for the percentage of covered lives receiving care under an APM, starting in 2025. The target percentage should be based on the data reported by payers starting in 2023 and should be vetted by the Collaborative and other impacted groups before going into effect.

Besides the value-based care goals, other key goals the Collaborative identified include centering health equity in primary care, integrating behavioral healthcare within the primary care setting, and increasing collaboration between primary care and public health.