(1) The commissioner shall convene a primary care payment reform collaborative to:
Consult with the department of personnel, the executive director of the department ofhealth care policy and financing, and the administrator of the Colorado all-payer health claims database described in section 25.5-1-204;
Advise in the development of the affordability standards and targets for carrier investments in primary care established in accordance with section 10-16-107 (3.5);
In coordination with the administrator of the all-payer claims database described insection 25.5-1-204, analyze the percentage of medical expenses allocated to primary care:
By health insurers;
Under the "Colorado Medical Assistance Act", articles 4, 5, and 6 of title 25.5; and
Under the "Children's Basic Health Plan Act", article 8 of title 25.5;
Develop a recommendation to the commissioner on the definition of primary care forthe purposes of this section;
Report on current health insurer practices and methods of reimbursement that directgreater health care resources and investments toward health care innovation and care improvement in primary care;
Identify barriers to the adoption of alternative payment models by health insurers andproviders, and develop recommendations to address the barriers;
Develop recommendations to increase the use of alternative payment models that arenot paid on a fee-for-service or per-claim basis to:
Increase the investment in advanced primary care delivered by practices that are patient-centered medical homes as defined by national or state-recognized criteria or that have demonstrated the ability to provide high-quality primary care;
Align primary care reimbursement by all consumers of primary care; and
Direct investment toward higher value primary care services with an aim towardreducing health disparities;
Consider how to increase investment in advanced primary care without increasingcosts to consumers or increasing the total cost of health care; and
Develop and share best practices and technical assistance to health insurers and consumers, which may include:
Aligning quality metrics as developed in the state innovation model;
Facilitating the integration of behavioral and physical primary care;
Practice transformation; and
The delivery of advanced primary care that facilitates appropriate utilization of services in appropriate settings.
(2) The commissioner shall invite representatives from the following to participate in the primary care payment reform collaborative:
Health care providers, including primary care providers;
Health care consumers;
Employers that purchase health insurance for employees and employers that offerself-insured health benefit plans;
Health insurers, including entities that contract with the department of health carepolicy and financing as managed care entities;
The federal centers for medicare and medicaid services;
The primary care office in the department of public health and environment createdpursuant to section 25-1.5-403;
The executive director of the department of health care policy and financing; and(h) Experts in health insurance actuarial analysis.
The commissioner shall convene the primary care payment reform collaborative onor before July 15, 2019.
By December 15, 2019, and by each December 15 thereafter, the primary care payment reform collaborative shall publish primary care payment reform recommendations, informed by the primary care spending report prepared in accordance with section 25.5-1-204 (3)(c). The collaborative shall make the report available electronically to the general public.
The division may seek, accept, and expend gifts, grants, or donations from private orpublic sources for the purposes of this section.
As used in this section, "health insurer" means:
A carrier that is subject to part 2, 3, or 4 of this article 16 and that is offering healthbenefit plans in Colorado; and
A carrier that provides or administers a group benefit plan for state employees pursuant to part 6 of article 50 of title 24.
(7) This section is repealed, effective September 1, 2025. Before the repeal, the functions of the primary care payment reform collaborative are scheduled for review in accordance with section 24-34-104.
Source: L. 2019: Entire section added, (HB 19-1233), ch. 194, p. 2119, § 2, effective May 16.
Cross references: For the legislative declaration in HB 19-1233, see section 1 of chapter 194, Session Laws of Colorado 2019.