First-of-its-kind program focuses on innovative, data-driven efforts to improve quality of care
Cambridge, MA – Local health care leaders are introducing an innovative Value-Based Purchasing (VBP) program that strengthens skilled nursing facilities’ efforts to continue to improve the quality of care for New Mexicans.
The goal of the program is to encourage and financially reward a nursing facility’s ability to increase access to critical resources in ways that haven’t been supported before, particularly in rural communities. One of the program’s key focus areas is expanding telehealth options so more clinicians can provide treatment recommendations via phone or video while the resident is still in the nursing home. Telehealth creates a better experience and outcomes for nursing home residents by avoiding the disruption and added risk of being admitted to a hospital.
New Mexico’s VBP program is the first state quality program developed as a collaborative effort between industry and state partners to focus on the continual improvement of the quality of skilled nursing patient care. Led by the vision and expertise of Dr. David Scrase, secretary of the Human Services Department (HSD), the group includes HSD, New Mexico Health Care Association (NMHCA) and three Medicaid managed care organizations (MCOs) – Blue Cross and Blue Shield of New Mexico (BCBSNM), Presbyterian Health Plan (PHP) and Western Sky Community Care (WSCC).
“This effort has been a genuine collaboration amongst all stakeholders to create a sustainable, equitable, evidence- and quality-based incentive structure for facilities caring for our state’s most vulnerable residents,” said Mary Eden, senior vice president of Government Programs at Presbyterian Health Plan.
“BCBSNM is pleased to have the opportunity to collaborate with the Human Services Department and other stakeholders to refine and advance innovative strategies for rewarding value-based long-term care services,” said Sharon Huerta, vice president of Medicaid Operations for BCBSNM. “Shifting away from fee-for-service systems to value-based payment models that tie provider payments to patient outcomes is optimal.”
“Western Sky Community Care is pleased to be a part of this collaborative effort between HSD, providers and payors to improve the lives of the most fragile New Mexicans. We truly see this multi-faceted partnership as a gold standard that should be replicated in future endeavors,” said Nathan Cogburn, vice president of Network Development, Western Sky Community Care.
“The importance of unified cross-industry support for our skilled nursing providers has never been more critical,” said Vicente Vargas, executive director at NMHCA. “Our VBP program acts on the joint commitment of New Mexico’s health care leaders to ensure continual support of the state’s skilled nursing providers and, most importantly, to the residents they serve.”
To ensure data the providers use is current and actionable the group contracted with PointRight (www.pointright.com) as its data and advanced analytics partner. PointRight’s ability to calculate clinical quality measures with incentive payments and to provide these real-time insights through an online dashboard report available to all the participating SNFs is an asset.
“After evaluating multiple vendors, we selected PointRight because they were the only vendor capable of providing real-time evidence-based measures required for the success of the program”, said a spokesperson on behalf of the New Mexico VBP Vendor Selection Committee. “They have become a valued, trusted partner as we continue to roll-out this program to participating facilities.”
The New Mexico VBP program is in place through 2021, with an option to extend to 2023, to ensure a long-term, sustained focus on these continued quality improvements to benefit long-term care residents.
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