The Ask the Analyst series is a deep dive into the data by those most familiar with the CO APCD – the analysts themselves. We’ll hear about their experiences with recent analyses and answer any pressing questions that come up. Have a question for the CIVHC Analyst Team? Email it to


Analyst Name: Maria de Jesus Diaz-Perez

Featured Project: Primary Care Spending and Alternative Payment Models

Established in 2019 by House Bill 19-1233, the Primary Care Payment Reform Collaborative is a multi-stakeholder group tasked with developing strategies to ensure that Colorado’s health care system is investing in affordable, sustainable, and accessible primary care for all residents. CIVHC supports the Collaborative by providing an annual report on primary care spending and alternative payment models (APMs). Using this report, the Collaborative makes recommendations to the Commissioner of Insurance and the Colorado General Assembly.

A large and diverse team has contributed to the Primary Care and APM reports over the years, ranging from CIVHC analysts to staff at the Colorado Division of Insurance (DOI) as well as all the payers who make the analysis possible. I have been fortunate to be involved in this project in different ways since it launched in 2019.

What were the first steps when beginning this analysis?

There were two essential first steps:

  1. Define what services are included under primary care.

Once the Collaborative agreed on a definition of primary care for Colorado, CIVHC worked closely with them and the Division of Insurance (DOI) to make it functional for data collection and reporting.

  1. Define and collect APM data

CIVHC collaborated with the DOI and payers to select a nationally recognized framework to classify and describe APMs and then set up a process to collect and analyze the data.

Were there specific things that needed to be considered based on the data?

Payers have submitted APM data to the Colorado All Payer Claims Database (CO APCD) for only a few years and the files collected in 2021 were the second time the current methodology was used.

Given this relative newness, each year there are lots of lessons learned. Most recently, using the lessons from the 2020 collection cycle, the data intake and analyst team designed several new ways to ensure that the data submitted was accurate that proved invaluable. In 2021, the APM submission process was as follows:

  1. Each payer was required to submit a test file in July 2021, with a subsequent review period of the file during which the CIVHC team validated them and shared the findings with the payers.
    • New this year, the validation analysis and findings included a qualitative summary of each payer’s APM contracts based on the submission requirements, indicating where payers summarized the key elements of each contract (e.g. is it population based, are there measures of quality, does it include claims-based and/or non-claims payments?).
  2. In September, the actual files were due and also underwent a validation period. Following these submissions, CIVHC met with each payer to provide additional support, verify findings, and aid the payers in revising their files as needed.
    • Again, the qualitative analysis was included in the findings reported to the payers.

What challenges did you encounter while performing the analysis? How did you overcome them?

The main challenge is that this is still relatively new data collection. CIVHC’s analyst team worked very closely with the payers as described above and also designed several quality control steps to make sure the data was collected as instructed. This is crucial to producing reliable information across payers, as well as producing information that the Collaborative can use to make recommendations regarding primary care spending in Colorado.

Without delving into results, did anything surprise you about this analysis or the process of executing it?

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Not necessarily a surprise but I was reminded throughout the process of collecting, validating, and revising APM data files from payers that even when tasks are hard, working in close collaboration with your partners (in this case the payers), in a systematic and transparent way, usually brings very good results.

What did you learn while performing this analysis?

I learned that we still have much to learn about the implementation and use of APMs and therefore, collecting data about them. We also have much to learn about the impact of APMs in decreasing or controlling spending, improving quality of care, promoting equitable health outcomes, and increasing provider satisfaction. I am certain that as we keep learning about these payments, we will also keep learning about their impact in overall health care performance. When that time comes, we might need to modify the ways in which we collect data and be ready to answer additional questions about APM impact in Colorado’s health care performance.

Learn more about CIVHC’s work on APMs:

  • Primary Care Payment Reform Collaborative
  • Statewide APM data on the Affordability Dashboard (coming late June 2022)
  • CIVHC’s Journey with APMs