Alternative Payment Models

Alternative Payment Models in Colorado

The new version of the Alternative Payment Model (APM) Analysis (released July 2022) is now available on the Affordability Dashboard.

Health care costs in Colorado continue to climb every year, increasing 14 percent between 2013 and 2017. In response, stakeholders from across the state have been trying to find solutions with the aim of curbing the rising prices while improving quality of care and the health of Coloradans. Health insurers in particular have been partnering with providers and facilities to link payments to high value care, which is also often referred to as payment reform, or alternative payment models (APMs).

APMs and Payment Reform in Colorado Issue Brief

Issue Brief Draft_v9_FINAL

A History of Connecting Cost to Quality

  • 2008 - CO APCD recommended by Blue Ribbon Commission for Health Care Reform.
  • 2009 - CIVHC begins as a convener of diverse stakeholders committed to changing the way care is paid for and delivered.
  • 2010 - CIVHC appointed Administrator of CO APCD.
  • 2012-2014 - Drafting and application period of the State Innovation Model (SIM) grant from the Center for Medicare & Medicaid Innovation (CMMI). CIVHC is prominent in the drafting process and convenes the Public Health Workgroup, due to experience incorporating public health into new delivery and payment models. Colorado award $65 million for the SIM program in December 2014.
  • 2015/2016 - Working with the Department of Health Care Policy and Financing (HCPF) and other stakeholders, CIVHC begins developing analytics for episodes of care using APCD data.
  • 2017 - CIVHC selected by Catalyst for Payment Reform (CPR) to help develop Colorado Payment Reform Scorecards. CIVHC begins the process of a rule change governing submissions to the CO APCD to begin collect APM information.
  • 2018 - CIVHC and CPR release the results of The Colorado Scorecards on Payment Reform, which found that over half (57%) of health care payments by the commercial sector in 2016 contained incentives to improve care patients received.
    • Collaboration with the submitters to collect APM information in the CO APCD begins.
  • 2019 - The first APM file submissions arrive in the CO APCD in September.
    • The Primary Care and Payment Reform Collaborative releases their first set of recommendations to the Commissioner of Insurance and Colorado General Assembly.
  • 2020 - CPR, the Colorado Division of Insurance, and CIVHC partner with the submitters to refine the APM files and APM categories.