Payment Reform

People across the country are struggling to access primary care, despite its importance as the foundation of the health care system. Shifting away from FFS to APMs is one approach to better support primary care and address poor health outcomes and rising health care costs in the United States. APMs are designed to improve care delivery, reward quality, and incentivize cost control.

The Farley Center conducted research funded by Arnold Ventures examining five states that are advancing primary care APM policy for the commercial sector. Insights from these states provide useful takeaways and points of caution for others beginning this work. Results are summarized in the following products:

• The policy playbook presents a step-by-step guide for state policymakers and policy influencers looking to support high-quality primary care by transforming payment.
• The full report delves into the detailed findings of the research, as well as a more comprehensive listing of recommendations for states advancing primary care payment reform.
• State snapshots provide a brief overview of major policies in primary care payment reform in Arkansas, Colorado, Delaware, Rhode Island, and Washington.

The Farley Center has provided thought leadership through formal requests for information and policy workgroup leadership at the state and national level for many years. Examples include:

• In 2023, Lauren S. Hughes, MD, MPH, MSc, MHCDS, state policy director, was appointed co-chair of the Standing Committee on Primary Care within the National Academies of Sciences, Engineering, and Medicine through 2026. Stephanie Gold, MD, scholar, was announced as a recipient of the 2023-2025 James C. Puffer, MD/American Board of Family Medicine (ABFM) Fellowship at the National Academy of Medicine, and also served on the same Standing Committee on Primary Care.
• Since its inception in 2019, the Colorado Primary Care Payment Reform Collaborative (PCPRC) has included a faculty member from the Farley Center, including Stephanie Gold, MD, and Lauren S. Hughes, MD, MPH, MSc, MHCDS. They have contributed their expertise to each of the PCPRC’s annual reports, informing policy recommendations that would increase investment in advanced primary care without increasing costs to consumers and to direct health care systems away from fee-for-service models.
• Stephanie Gold has also participated on the Department of Health Care Policy and Financing (HCPF)’s Payment Model Design Team and APM2 Design Review Team, the Office of Saving People Money on Healthcare’s APM Alignment Primary Care Subgroup, and HCPF’s Health Care Practice Transformation Grant Program (HB22-1302) Steering Committee.
• The Farley Center submitted several public comments in response to federal requests for information relating to payment policy.

The COVID-19 pandemic has changed the delivery of health care in Colorado and across the country. One of the big shifts has been a rapid increase in services delivered via telemedicine, especially during the early days of the pandemic when strict stay-at-home restrictions were in place. To support greater use of telemedicine, the Colorado Department of Health Care Policy and Financing (HCPF) expanded the number of Health First Colorado (Colorado’s Medicaid program) services allowable for reimbursement and permitted more providers to be reimbursed for this modality. These changes were made, however, without the benefit of extensive research on telemedicine’s efficacy, the services most suited for this modality, its effects on access to care, whether it ameliorates or exacerbates already existing inequalities, and its impact on costs.

To help fill these research gaps and to support HCPF’s understanding of the impact of the new telemedicine policies, the Farley Health Policy Center evaluated medical appointment no-show rates, utilization and diagnoses for emergency department and primary care utilization, likelihood of a follow-up visit depending on visit modality, and preliminary budget implications.

Read the report: The Impact of Telemedicine Policy Changes on Health First Colorado Utilization and Costs.