Payer

HCPLAN Framework Level

SIM Model

Anthem Blue Cross Blue Shield

3

Enhanced Personal Healthcare (EPHC) or looking at individual provider’s fee schedule if EPHC is not available in their geography.

Cigna

3

PMPM with Share Savings Opportunity

Colorado Choice Health Plans

3

Per Member per Month Care Management Fee/ Shared Net Savings

Colorado Medicaid (Colorado Department of Health Care Policy and Financing)

2

Accountable Care Collaborative Behavioral Health Integration Program

Kaiser Permanente

3

Fee for Service, Fee for Service – Link to Quality & Value & Population Based Payments – MOU with Colorado Permanente Medical Group

Rocky Mountain Health Plans UnitedHealthcare of Colorado

3 and 4 2

Enhanced Fee-For-Service with shared savings/upside arrangements; Population Based Payments; Enhanced Global Payments Accountable Care Collaborative: Primary Care Physician Initiative/Behavioral Health Integration Program (PCPi/BHI)

1

MOU payer framework slide.pdf

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