Getting the care you need shouldn’t depend on where you live, your income, or whether you have a disability. That’s why changes in how health care is paid for — called payment reform — are helping make care more accessible, coordinated, and focused on your needs.
What Is Payment Reform?
Payment reform shifts how providers are paid for the care they deliver. Traditionally, providers have been paid for service volume, or the number of services they provide (fee-for-service). In newer reimbursement models, often called alternative payment models, providers are rewarded for high-quality, coordinated care and improved health outcomes while controlling costs. This care, focused on quality and outcomes, is called value-based care. Essentially, payment reform aligns incentives with outcomes, supporting the transition to value-based care and rewarding providers for the care that helps you most.
How Do Alternative Payment Models Close Health Care Gaps?
1. Encourages Preventive and Proactive Care
Instead of waiting until you’re sick, providers are supported to help you stay healthy. Preventive and proactive care includes regular checkups, screenings, and early management of conditions, such as diabetes and high blood pressure, to help prevent more serious health issues over time.
2. Improves Care Coordination
Payment reform supports better communication between your primary care provider (PCP), specialists, and community services. Better care coordination means fewer delays, less confusion, and more connected care, which is especially important for patients with complex or ongoing health needs.
3. Expands Access and Flexibility
New payment models allow providers to offer services that aren’t always covered in traditional systems, such as telehealth visits, in-home care, transportation to appointments, and longer appointment times when needed.
These options make it easier to get care, especially in rural areas or for those with mobility challenges.
4. Supports Disability Access and Accommodations
Providers can use flexible funding to improve accessible, inclusive, and culturally-appropriate care.
Examples include:
- Language interpretation and communication support
- Accessible equipment and clinic spaces
- Staff trained to support members with disabilities
5. Strengthens Community Outreach and Support
Payment reform also supports care beyond the clinic. Providers may collaborate with community organizations or community health workers to connect patients to local resources, including food, housing, or transportation assistance, or to support follow-up care after a hospital stay:
These efforts address social determinants of health and help reduce health disparities in underserved communities.
6. Promotes Lower Costs Through Better Care
Payment reform encourages providers to focus on keeping you healthy and avoiding unnecessary care, like preventable hospital visits or duplicate tests. By investing in prevention, coordination, and early treatment, providers can improve outcomes while lowering overall health care costs for both patients and the health care system.
How Payment Reform Impacts Medicaid Members in Colorado
Payment reform in Colorado helps create a system that is more focused on accessible, equitable, and whole-person care. It makes it easier for Health First Colorado (Colorado’s Medicaid Program) members to get the right care at the right time, whether that’s preventive services, behavioral health support, or help navigating their care.
