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).
"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.”
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.
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.