posted by Alicia Caramenico
on May 19, 2016
Effective partnerships between providers and health plans are demonstrating real results in terms of better care, smarter spending, and healthier populations. At Rocky Mountain Health Plans (RMHP) in Colorado, this takes the form of the value-based Advanced Primary Care Model. In this model, fully integrated, team-based primary care practices receive non-volume, non-encounter, risk-adjusted payments with opportunities for shared savings.
Provider support is a key element and RMHP works collaboratively with Advanced Primary Care practices to improve the cost and quality of care. The health plan provides regular feedback to practices, including monthly reports and in-person reviews on utilization and cost. In evaluating Advanced Primary Care Model practices against network peers in conventional fee-for-service (FFS) contracts, total costs per member per month are lower within the model by about 4.54 percent.
For quality measurement, Rocky Mountain’s ACP follows a less is more philosophy and intentionally aligns measures around existing policy initiatives, such as Meaningful Use, state innovation models, and those used in Medicare, Medicaid, and the Exchange marketplace.
RMHP aims to continue to grow its Advanced Primary Care Model and fully implement risk-adjusted, global payment, which it’s already done for some groups. As the Advanced Primary Care Model grows and thrives at RMHP, health plans will continue to move us toward a system that incentivizes the delivery of care most likely to keep patients healthy.
Note: This content was based on presentations at the AHIP Payment Reform Summit in October 2015.