Primary care collaborative releases recommendations report on moving towards value-based care and equitable outcomes

The Colorado Primary Care Payment Collaborative (the Collaborative) released its third annual recommendations report recently, offering guidance on how to strengthen their primary care system and increase investments in delivery.

The report builds on recommendations made in previous years and specifically focuses on investments in primary care, centering care delivery and payment methods around equity, advancing behavioral health and physical health integration, and enhancing coordination with public health. 

 

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The Collaborative was created upon passage of House Bill 19-1233 hosted by the Division of Insurance (DOI) in the Department of Regulatory Agencies (DORA). The Collaborative consists of plans, providers, and state agency officials from all silos of Colorado. 

Its mission is to “[work] to develop recommendations and strategies for payment system reforms to reduce health care costs by increasing use of primary care.” The legislature can then enact policy based on the recommendations. 

Guiding further investments in primary care

The Collaborative “reaffirms”—from the last two annual recommendations—that Colorado increases investment in primary care through the building of greater infrastructure and the shift to a value-based payment (VBP) model. It recommends increasing primary care funding by 1% in 2022-2023.

“The one percentage point increased investment in primary care required in 2022 and 2023 should primarily be directed through non-FFS [fee-for-service] mechanisms, including APMs [alternative payment models] that offer prospective funding and infrastructure investments.” 

The report said VBP models would improve quality, accessibility, and affordability for Coloradans. Effective APMs support the goal of getting people the right care at the right time by covering more people and addressing health issues earlier in the continuum of care. 

Because of this, the report recommended that all commercial payers should offer at least one APM that includes prospective payments for advanced primary care delivery by 2023. It said that payers should also include percentages of “covered lives” receiving care under these APMs annually to DOI starting in 2023. 

In future work, the Collaborative will continue to discuss the provider role in the adoption of APMs in plans and the determining factors in their adoption. 

Centering care delivery and payment methods around equity

The report said health equity must be at the center of the design of any APM. A VBP model—especially—can help support providers to focus on improving qualitative and more equitable outcomes for their patients. 

Below is a graph outlining the roles of different silos affecting primary care in advancing health equity.  

 

Image: Primary Care Payment Reform Collaborative

 

To refine APMs to prioritize equitable outcomes, the report recommended starting by building a foundation for equity. The report said:

“The collaborative recognizes that traditional FFS methodologies can both disadvantage practices and perpetuate health disparities by failing to meet the needs of patients with the highest barriers to care… The Collaborative proposed three key actions for building a foundation for equity in APMs: Proposing an initial definition for what constitutes an equitable APM, investing in foundational capabilities for equity, and guarding against exacerbation of disparities.”

For future work, the report recommended widespread adoption of cultural competency training and continuing to lay the groundwork for further action in greater detail.  

Advancing behavioral health and physical health integration

The Collaborative continued to recommend the integration of behavioral health and physical health for primary care delivery and payment reform. 

In terms of payment integration, the report recommended a move away from an FFS model and towards a VBP model. They also recommended increasing resources to integration efforts and expanding infrastructure to give policymakers a “line of sight” into the investments and how they can impact higher quality outcomes.

The report also recommended eliminating copayment for same-day behavioral health visits occurring in an integrated care setting. The report said:

“For some patients, a second copayment can be a barrier to receiving a behavioral health service if it is offered on the same day within an integrated, team-based setting… The benefit to patients of removing a barrier to access is clear.” 

In the delivery space, the report recommends greater communication between providers, cross-sector collaboration, and central site of care delivery for both behavioral and physical health services. 

Enhancing coordination with public health

The report recommended that expanded investments in primary care should support collaboration of public health agencies to improve prevention efforts and improve population health. 

“A strong relationship between primary care and public health can increase the efficiency and effectiveness of prevention and health promotion strategies and improve the treatment of health concerns.”

This graph shows some examples and how a relationship between primary care and public health would work. The graph outlines how this relationship should help prevent, intervene, and treat health conditions sooner in the continuum of care. 

 

Image: Primary Care Payment Reform Collaborative

 

The Collaborative will explore creating incentives for primary care and public health to move towards partnership.