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Colorado Primary Care Payment Reform Collaborative Application
Please fill out and submit the following application. Thank you for your interest in joining the Primary Care Payment Reform Collaborative!
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* Indicates required question
Name (First Last)
*
Your answer
Email
*
Your answer
Phone number
*
Your answer
Group represented
*
Choose
Health Care Provider (non-primary care)
Health Care Provider (primary care)
Health Care Consumer
Employer that purchases health insurance for employees
Employer that offers self-insured benefit plans
Health Insurer (does not contract with HCPF for Medicaid managed care)
Health Insurer (does contract with HCPF for Medicaid managed care)
Federal Center for Medicare and Medicaid Services
Primary Care Office in the Department of Public Health and Environment
Expert in Health Actuarial Analysis
Please give a brief description of your professional background:
*
Your answer
Please give a brief description of your interest in participating in The Collaborative:
*
Your answer
Will you be able to commit 4-6 hours per month between July 2022-June 2023 on Collaborative-related work and/or meetings?
*
Yes
No
Maybe
What unique perspectives will you bring to inform the Collaborative's work?
Your answer
Please indicate your location:
Denver Metro Area
Western Slope
Eastern Plains
Mountain Communities (Summit, Eagle, Vail, Aspen, etc)
Northern Front Range (Boulder, Fort Collins, Greeley, etc)
Southern Colorado (Colorado Springs, Pueblo, Alamosa, etc)
Other:
Clear selection
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