USE CASE: Value-Based Payment Model Development

A health insurance payer in Colorado looking to improve care and lower costs, intended to develop value-based Accountable Care Organization (ACO) contracts and other value-based payment arrangements.  Through value-based ACOs with providers, this payer intended to change the reimbursement structure from the typical fee-for-service reimbursement structure which focuses solely on volume, to new payment models that encourage providers to shift focus to keeping patients healthy and providing excellent care with desired outcomes.

Request Summary This used the CO APCD to determine the best approach to enter the individual market with a value-based reimbursement model. by determining appropriate rates based on various geographic cost factors and available physicians and hospitals.  They also used the CO APCD data as a more credible source to provide benchmarks for improving existing small and large employer value-based arrangements.

Benefit to Colorado This benefits Colorado residents by supporting development and availability of new payment models aimed at reducing health care costs and improving health and health care.

Categories: CO APCDHealth Plan

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