David Scrase Tracy Smith and Erica ArchuletaMedicaid Advisory Committee

November 5 2018

New Mexico Medicaid Value Based Purchasing and Nursing Facilities

Agendabull Hepatitis C follow-up from MAC meeting on November 17 2015bull Population changes in New Mexico (why is this topic so important)bull Brief overview of value based purchasing (VBP) in the United Statesbull VPB in New Mexico Medicaidbull Nursing Facility-specific VBP in other states (Texas California)bull Project ECHObull Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA)

Program in New Mexico (2018 Pilot and 2019-2023 VBP Program)bull Conclusions what we have learned so far

Follow-Up on Hepatitis C

150

459

963

1264

1400

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

1400

1600

2014 2015 2016 2017 2018Projected

Members Treated

Approval of Authorization for HCV Treatment

F3-F1-F4 All HCV F2-F4 All HCV

Population Changes in New Mexico (why is this topic so important)

New Mexico Population Data Sourcesbull UNM BBER Population Data 1900-2010bull UNM Geospatial and Population Studies

(GPS) 2020-2040 Robert Rhatiganbull West LA Cole S Goodkind D He W

65+ in the United States 2010 US Bureau of Census 2014

UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and overAGE

New Mexico Age-Sex Distribution 1900

Source BBER UNM

Male Female

Agendabull Hepatitis C follow-up from MAC meeting on November 17 2015bull Population changes in New Mexico (why is this topic so important)bull Brief overview of value based purchasing (VBP) in the United Statesbull VPB in New Mexico Medicaidbull Nursing Facility-specific VBP in other states (Texas California)bull Project ECHObull Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA)

Program in New Mexico (2018 Pilot and 2019-2023 VBP Program)bull Conclusions what we have learned so far

Follow-Up on Hepatitis C

150

459

963

1264

1400

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

1400

1600

2014 2015 2016 2017 2018Projected

Members Treated

Approval of Authorization for HCV Treatment

F3-F1-F4 All HCV F2-F4 All HCV

Population Changes in New Mexico (why is this topic so important)

New Mexico Population Data Sourcesbull UNM BBER Population Data 1900-2010bull UNM Geospatial and Population Studies

(GPS) 2020-2040 Robert Rhatiganbull West LA Cole S Goodkind D He W

65+ in the United States 2010 US Bureau of Census 2014

UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and overAGE

New Mexico Age-Sex Distribution 1900

Source BBER UNM

Male Female

Follow-Up on Hepatitis C

150

459

963

1264

1400

0

10

20

30

40

50

60

70

80

90

100

0

200

400

600

800

1000

1200

1400

1600

2014 2015 2016 2017 2018Projected

Members Treated

Approval of Authorization for HCV Treatment

F3-F1-F4 All HCV F2-F4 All HCV

Population Changes in New Mexico (why is this topic so important)

New Mexico Population Data Sourcesbull UNM BBER Population Data 1900-2010bull UNM Geospatial and Population Studies

(GPS) 2020-2040 Robert Rhatiganbull West LA Cole S Goodkind D He W

65+ in the United States 2010 US Bureau of Census 2014

UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and overAGE

New Mexico Age-Sex Distribution 1900

Source BBER UNM

Male Female

Population Changes in New Mexico (why is this topic so important)

New Mexico Population Data Sourcesbull UNM BBER Population Data 1900-2010bull UNM Geospatial and Population Studies

(GPS) 2020-2040 Robert Rhatiganbull West LA Cole S Goodkind D He W

65+ in the United States 2010 US Bureau of Census 2014

UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and overAGE

New Mexico Age-Sex Distribution 1900

Source BBER UNM

Male Female

UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and overAGE

New Mexico Age-Sex Distribution 1900

Source BBER UNM

Male Female

UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico Age-Sex Distribution 1910

Source BBER UNM

Male Female

UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico Age-Sex Distribution 1920

Source BBER UNM

Male Female

UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico Age-Sex Distribution 1930

Source BBER UNM

Male Female

UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico Age-Sex Distribution 1940

Source BBER UNM

Male Female

UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico Age-Sex Distribution 1950 (Baby Boomers 0-4)

Source BBER UNM

Male Female

UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico Age-Sex Distribution 1960 (Baby Boomers 0-14)

Source BBER UNM

Male Female

UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico Age-Sex Distribution 1970 (Baby Boomers 5-24)

Source BBER UNM

Male Female

UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico Age-Sex Distribution 1980 (Baby Boomers 15-

Source BBER UNM

Male Female

UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico Age-Sex Distribution 1990 (Baby Boomers 25-44)

Source BBER UNM

Male Female

UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico Age-Sex Distribution 2000 (Baby Boomers 35-54)

Source BBER UNM

Male Female

UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico Age-Sex Distribution 2010 (Baby Boomers 45-64)

Source BBER UNM

Male Female

Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020

httpgpsunmedudataPopulation20Projectionshtml

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico Age-Sex Distribution 2020 (Baby Boomers 55-74)

Source GPS UNM

Male Female

Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030

httpgpsunmedudataPopulation20Projectionshtml

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico Age-Sex Distribution 2030 (Baby Boomers 65-84)

Source GPS UNM

Male Female

Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040

httpgpsunmedudataPopulation20Projectionshtml

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico Age-Sex Distribution 2040 (Baby Boomers 75-94)

Source GPS UNM

Male Female

NM Population 1900 and 2030

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico

Source GPS UNM

Male Female

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and overAGE

New Mexico

Source BBER UNM

Male Female

World US and NM Population Data1900

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and overAGE

New Mexico

Source BBER UNM

Male Female

World US and NM Population Data 1970

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico

Source BBER UNM

Male Female

World US and NM Population Data 2010

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico

Source BBER UNM

Male Female

World US and NM Population Projections 2030

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico

Source GPS UNM

Male Female

In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030

bull 4th

bull 14th

bull 24th

bull 34th

bull 44th

Ranking of States by projected population age 65 and over 2000 2010 and 2030ldquoOlder AmericansmdashA Diverse and Growing Population Growing Old in America Barbara Wexler 2008

httpicgalegroupcomicovicReferenceDetailsPageDocumentToolsPortletWindow displayGroupName=Referenceampjsid=39089e482c48b82edbb8752954d5c460ampaction=2ampcatId=ampdocumentId=GALE7CEJ3011870101ampu=tel_s_tslaampzid=a8b62bf67a1e49125e7d00fb3ad9b66d last accessed 1242016

World US and NM Population Data1900

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and overAGE

New Mexico

Source BBER UNM

Male Female

World US and NM Population Data 1970

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico

Source BBER UNM

Male Female

World US and NM Population Data 2010

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico

Source BBER UNM

Male Female

World US and NM Population Projections 2030

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico

Source GPS UNM

Male Female

In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030

bull 4th

bull 14th

bull 24th

bull 34th

bull 44th

Ranking of States by projected population age 65 and over 2000 2010 and 2030ldquoOlder AmericansmdashA Diverse and Growing Population Growing Old in America Barbara Wexler 2008

httpicgalegroupcomicovicReferenceDetailsPageDocumentToolsPortletWindow displayGroupName=Referenceampjsid=39089e482c48b82edbb8752954d5c460ampaction=2ampcatId=ampdocumentId=GALE7CEJ3011870101ampu=tel_s_tslaampzid=a8b62bf67a1e49125e7d00fb3ad9b66d last accessed 1242016

World US and NM Population Data 1970

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico

Source BBER UNM

Male Female

World US and NM Population Data 2010

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico

Source BBER UNM

Male Female

World US and NM Population Projections 2030

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico

Source GPS UNM

Male Female

In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030

bull 4th

bull 14th

bull 24th

bull 34th

bull 44th

Ranking of States by projected population age 65 and over 2000 2010 and 2030ldquoOlder AmericansmdashA Diverse and Growing Population Growing Old in America Barbara Wexler 2008

httpicgalegroupcomicovicReferenceDetailsPageDocumentToolsPortletWindow displayGroupName=Referenceampjsid=39089e482c48b82edbb8752954d5c460ampaction=2ampcatId=ampdocumentId=GALE7CEJ3011870101ampu=tel_s_tslaampzid=a8b62bf67a1e49125e7d00fb3ad9b66d last accessed 1242016

World US and NM Population Data 2010

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico

Source BBER UNM

Male Female

World US and NM Population Projections 2030

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico

Source GPS UNM

Male Female

In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030

bull 4th

bull 14th

bull 24th

bull 34th

bull 44th

Ranking of States by projected population age 65 and over 2000 2010 and 2030ldquoOlder AmericansmdashA Diverse and Growing Population Growing Old in America Barbara Wexler 2008

httpicgalegroupcomicovicReferenceDetailsPageDocumentToolsPortletWindow displayGroupName=Referenceampjsid=39089e482c48b82edbb8752954d5c460ampaction=2ampcatId=ampdocumentId=GALE7CEJ3011870101ampu=tel_s_tslaampzid=a8b62bf67a1e49125e7d00fb3ad9b66d last accessed 1242016

World US and NM Population Projections 2030

100000 75000 50000 25000 0 25000 50000 75000 100000

0 to 45 to 9

10 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 84

85 and over

AGE New Mexico

Source GPS UNM

Male Female

In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030

bull 4th

bull 14th

bull 24th

bull 34th

bull 44th

Ranking of States by projected population age 65 and over 2000 2010 and 2030ldquoOlder AmericansmdashA Diverse and Growing Population Growing Old in America Barbara Wexler 2008

httpicgalegroupcomicovicReferenceDetailsPageDocumentToolsPortletWindow displayGroupName=Referenceampjsid=39089e482c48b82edbb8752954d5c460ampaction=2ampcatId=ampdocumentId=GALE7CEJ3011870101ampu=tel_s_tslaampzid=a8b62bf67a1e49125e7d00fb3ad9b66d last accessed 1242016

In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030

bull 4th

bull 14th

bull 24th

bull 34th

bull 44th

Ranking of States by projected population age 65 and over 2000 2010 and 2030ldquoOlder AmericansmdashA Diverse and Growing Population Growing Old in America Barbara Wexler 2008

httpicgalegroupcomicovicReferenceDetailsPageDocumentToolsPortletWindow displayGroupName=Referenceampjsid=39089e482c48b82edbb8752954d5c460ampaction=2ampcatId=ampdocumentId=GALE7CEJ3011870101ampu=tel_s_tslaampzid=a8b62bf67a1e49125e7d00fb3ad9b66d last accessed 1242016

Ranking of States by projected population age 65 and over 2000 2010 and 2030ldquoOlder AmericansmdashA Diverse and Growing Population Growing Old in America Barbara Wexler 2008

httpicgalegroupcomicovicReferenceDetailsPageDocumentToolsPortletWindow displayGroupName=Referenceampjsid=39089e482c48b82edbb8752954d5c460ampaction=2ampcatId=ampdocumentId=GALE7CEJ3011870101ampu=tel_s_tslaampzid=a8b62bf67a1e49125e7d00fb3ad9b66d last accessed 1242016

Important Differences in Health Services Use Rates in Older Population Demographics

bull Use rates for all adult healthcare services are higher for those gt 64ndash Use rates for ages 65-84 are 20 to 35 times use rates of those lt65 (weighted

average ~ 3x)ndash Use rates for ages 85 and above are 35 to 115 times use rates of those lt65

(weighted average ~ 6x)

bull The aggregate impact of population growth and use rates will require NM to expand virtually all categories of healthcare services by 30 to 45 percent between 2010 and the year 2030

bull Nursing home use in NM could double

Brief Overview of Value Based Purchasing (VBP) in the United States

History

bull In 1983 the federal government implemented DRGs the first VBP program whichndash Stopped paying per diem ratesndash Started paying a fixed fee for

hospitalizations by diagnosis

bull CMS has been a consistent leader in program development since then

What does ldquoValuerdquo Mean

bull What you get divided by what you pay for (Quality Cost)

bull Fee for Service payments reward providers for doing more not necessarily for doing ldquobetterrdquo

bull Payers are now moving to payment systems to reward quality of care and outcomes

2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Per Unit and Value Based Reimbursement Model

Value-BasedReimbursement

Per UnitReimbursement

1

2 3

Why Implement VBP Programs in Nursing Facilities

bull Robust data (MDS) and established reporting system

bull Changing CMS incentivesbull Manageable number of

providers

Why Implement VBP Programs in Nursing Facilities

bull The Minimum Data Set (MDS) is part of the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified nursing homes

bull Established and refined mid-1990sbull This process provides a comprehensive assessment

of each residents functional capabilities and helps nursing home staff identify health problems

bull ldquoNo new measuresrdquo

Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs

bull HR 4302 the Protecting Access to Medicare Act of 2014legislates a value-based purchasing (VBP) program for skilled nursing facilities (SNFs)

bull Establishes a hospital readmissions reduction program for these providers encouraging SNFs to address potentially avoidable readmissions by establishing an incentive pool for high performers

bull The Congressional Budget Office scored the program to save Medicare $2 billion over the next 10 years

CMS and Nursing Facility VBP

Key NM Medicaid Nursing Facility Facts

bull Medicaid pays for about 14 M NF days per year

bull Medicaid is the primary payer for gt90 of Long Term Care facility days

bull There are only 76 licensed NFs in New Mexico (compared to gt 1000 in California and Texas)

VBP in New Mexico Medicaid

Traditional Medicaid and Other Programs

Medicaid Expansion under the ACA

2774

72262014 1002015 1002016 1002017 952018 942019 93

2020 on 90

NM General Fund

NM General Fund

Federal Government

Federal Government

2014 02015 02016 02017 52018 62019 7

2020 on 10

2019 Medicaid Managed Care Organizations(BCBS Presbyterian Western Skies)

New Mexico

Hospitals

NM Medical Groups

Home Care

Dentists DME Providers

Many Others

Skilled and Long Term Care NFs

$1$260 $1$19 -gt$1$9

Oversimplified View of Health Care Financing through Centennial Care

14 M nursing facility bed days per yearand gt90 LTC bed days

How VBP ldquoWorksrdquo

Centennial Care Timeline

2014 2015 2016 2017

Centennial Care Initiated(112014)

Final Waiver Application CMS

Review and Approval(112017-122018)

Centennial Care 20 Stakeholder Input(102016-62017)

bull Subcommittee of the MAC

bull Tribal Consultation

bull Concept Paper

bull Public meetings

Draft Waiver Application and Public

Comment(92017-112017)

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Only 56 days from today

VBP Requirements in CC 20 RFP

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

Brief Overview of Value Based Purchasing (VBP) in the United States

History

bull In 1983 the federal government implemented DRGs the first VBP program whichndash Stopped paying per diem ratesndash Started paying a fixed fee for

hospitalizations by diagnosis

bull CMS has been a consistent leader in program development since then

What does ldquoValuerdquo Mean

bull What you get divided by what you pay for (Quality Cost)

bull Fee for Service payments reward providers for doing more not necessarily for doing ldquobetterrdquo

bull Payers are now moving to payment systems to reward quality of care and outcomes

2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Per Unit and Value Based Reimbursement Model

Value-BasedReimbursement

Per UnitReimbursement

1

2 3

Why Implement VBP Programs in Nursing Facilities

bull Robust data (MDS) and established reporting system

bull Changing CMS incentivesbull Manageable number of

providers

Why Implement VBP Programs in Nursing Facilities

bull The Minimum Data Set (MDS) is part of the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified nursing homes

bull Established and refined mid-1990sbull This process provides a comprehensive assessment

of each residents functional capabilities and helps nursing home staff identify health problems

bull ldquoNo new measuresrdquo

Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs

bull HR 4302 the Protecting Access to Medicare Act of 2014legislates a value-based purchasing (VBP) program for skilled nursing facilities (SNFs)

bull Establishes a hospital readmissions reduction program for these providers encouraging SNFs to address potentially avoidable readmissions by establishing an incentive pool for high performers

bull The Congressional Budget Office scored the program to save Medicare $2 billion over the next 10 years

CMS and Nursing Facility VBP

Key NM Medicaid Nursing Facility Facts

bull Medicaid pays for about 14 M NF days per year

bull Medicaid is the primary payer for gt90 of Long Term Care facility days

bull There are only 76 licensed NFs in New Mexico (compared to gt 1000 in California and Texas)

VBP in New Mexico Medicaid

Traditional Medicaid and Other Programs

Medicaid Expansion under the ACA

2774

72262014 1002015 1002016 1002017 952018 942019 93

2020 on 90

NM General Fund

NM General Fund

Federal Government

Federal Government

2014 02015 02016 02017 52018 62019 7

2020 on 10

2019 Medicaid Managed Care Organizations(BCBS Presbyterian Western Skies)

New Mexico

Hospitals

NM Medical Groups

Home Care

Dentists DME Providers

Many Others

Skilled and Long Term Care NFs

$1$260 $1$19 -gt$1$9

Oversimplified View of Health Care Financing through Centennial Care

14 M nursing facility bed days per yearand gt90 LTC bed days

How VBP ldquoWorksrdquo

Centennial Care Timeline

2014 2015 2016 2017

Centennial Care Initiated(112014)

Final Waiver Application CMS

Review and Approval(112017-122018)

Centennial Care 20 Stakeholder Input(102016-62017)

bull Subcommittee of the MAC

bull Tribal Consultation

bull Concept Paper

bull Public meetings

Draft Waiver Application and Public

Comment(92017-112017)

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Only 56 days from today

VBP Requirements in CC 20 RFP

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

History

bull In 1983 the federal government implemented DRGs the first VBP program whichndash Stopped paying per diem ratesndash Started paying a fixed fee for

hospitalizations by diagnosis

bull CMS has been a consistent leader in program development since then

What does ldquoValuerdquo Mean

bull What you get divided by what you pay for (Quality Cost)

bull Fee for Service payments reward providers for doing more not necessarily for doing ldquobetterrdquo

bull Payers are now moving to payment systems to reward quality of care and outcomes

2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Per Unit and Value Based Reimbursement Model

Value-BasedReimbursement

Per UnitReimbursement

1

2 3

Why Implement VBP Programs in Nursing Facilities

bull Robust data (MDS) and established reporting system

bull Changing CMS incentivesbull Manageable number of

providers

Why Implement VBP Programs in Nursing Facilities

bull The Minimum Data Set (MDS) is part of the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified nursing homes

bull Established and refined mid-1990sbull This process provides a comprehensive assessment

of each residents functional capabilities and helps nursing home staff identify health problems

bull ldquoNo new measuresrdquo

Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs

bull HR 4302 the Protecting Access to Medicare Act of 2014legislates a value-based purchasing (VBP) program for skilled nursing facilities (SNFs)

bull Establishes a hospital readmissions reduction program for these providers encouraging SNFs to address potentially avoidable readmissions by establishing an incentive pool for high performers

bull The Congressional Budget Office scored the program to save Medicare $2 billion over the next 10 years

CMS and Nursing Facility VBP

Key NM Medicaid Nursing Facility Facts

bull Medicaid pays for about 14 M NF days per year

bull Medicaid is the primary payer for gt90 of Long Term Care facility days

bull There are only 76 licensed NFs in New Mexico (compared to gt 1000 in California and Texas)

VBP in New Mexico Medicaid

Traditional Medicaid and Other Programs

Medicaid Expansion under the ACA

2774

72262014 1002015 1002016 1002017 952018 942019 93

2020 on 90

NM General Fund

NM General Fund

Federal Government

Federal Government

2014 02015 02016 02017 52018 62019 7

2020 on 10

2019 Medicaid Managed Care Organizations(BCBS Presbyterian Western Skies)

New Mexico

Hospitals

NM Medical Groups

Home Care

Dentists DME Providers

Many Others

Skilled and Long Term Care NFs

$1$260 $1$19 -gt$1$9

Oversimplified View of Health Care Financing through Centennial Care

14 M nursing facility bed days per yearand gt90 LTC bed days

How VBP ldquoWorksrdquo

Centennial Care Timeline

2014 2015 2016 2017

Centennial Care Initiated(112014)

Final Waiver Application CMS

Review and Approval(112017-122018)

Centennial Care 20 Stakeholder Input(102016-62017)

bull Subcommittee of the MAC

bull Tribal Consultation

bull Concept Paper

bull Public meetings

Draft Waiver Application and Public

Comment(92017-112017)

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Only 56 days from today

VBP Requirements in CC 20 RFP

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

What does ldquoValuerdquo Mean

bull What you get divided by what you pay for (Quality Cost)

bull Fee for Service payments reward providers for doing more not necessarily for doing ldquobetterrdquo

bull Payers are now moving to payment systems to reward quality of care and outcomes

2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Per Unit and Value Based Reimbursement Model

Value-BasedReimbursement

Per UnitReimbursement

1

2 3

Why Implement VBP Programs in Nursing Facilities

bull Robust data (MDS) and established reporting system

bull Changing CMS incentivesbull Manageable number of

providers

Why Implement VBP Programs in Nursing Facilities

bull The Minimum Data Set (MDS) is part of the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified nursing homes

bull Established and refined mid-1990sbull This process provides a comprehensive assessment

of each residents functional capabilities and helps nursing home staff identify health problems

bull ldquoNo new measuresrdquo

Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs

bull HR 4302 the Protecting Access to Medicare Act of 2014legislates a value-based purchasing (VBP) program for skilled nursing facilities (SNFs)

bull Establishes a hospital readmissions reduction program for these providers encouraging SNFs to address potentially avoidable readmissions by establishing an incentive pool for high performers

bull The Congressional Budget Office scored the program to save Medicare $2 billion over the next 10 years

CMS and Nursing Facility VBP

Key NM Medicaid Nursing Facility Facts

bull Medicaid pays for about 14 M NF days per year

bull Medicaid is the primary payer for gt90 of Long Term Care facility days

bull There are only 76 licensed NFs in New Mexico (compared to gt 1000 in California and Texas)

VBP in New Mexico Medicaid

Traditional Medicaid and Other Programs

Medicaid Expansion under the ACA

2774

72262014 1002015 1002016 1002017 952018 942019 93

2020 on 90

NM General Fund

NM General Fund

Federal Government

Federal Government

2014 02015 02016 02017 52018 62019 7

2020 on 10

2019 Medicaid Managed Care Organizations(BCBS Presbyterian Western Skies)

New Mexico

Hospitals

NM Medical Groups

Home Care

Dentists DME Providers

Many Others

Skilled and Long Term Care NFs

$1$260 $1$19 -gt$1$9

Oversimplified View of Health Care Financing through Centennial Care

14 M nursing facility bed days per yearand gt90 LTC bed days

How VBP ldquoWorksrdquo

Centennial Care Timeline

2014 2015 2016 2017

Centennial Care Initiated(112014)

Final Waiver Application CMS

Review and Approval(112017-122018)

Centennial Care 20 Stakeholder Input(102016-62017)

bull Subcommittee of the MAC

bull Tribal Consultation

bull Concept Paper

bull Public meetings

Draft Waiver Application and Public

Comment(92017-112017)

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Only 56 days from today

VBP Requirements in CC 20 RFP

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

Why Implement VBP Programs in Nursing Facilities

bull Robust data (MDS) and established reporting system

bull Changing CMS incentivesbull Manageable number of

providers

Why Implement VBP Programs in Nursing Facilities

bull The Minimum Data Set (MDS) is part of the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified nursing homes

bull Established and refined mid-1990sbull This process provides a comprehensive assessment

of each residents functional capabilities and helps nursing home staff identify health problems

bull ldquoNo new measuresrdquo

Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs

bull HR 4302 the Protecting Access to Medicare Act of 2014legislates a value-based purchasing (VBP) program for skilled nursing facilities (SNFs)

bull Establishes a hospital readmissions reduction program for these providers encouraging SNFs to address potentially avoidable readmissions by establishing an incentive pool for high performers

bull The Congressional Budget Office scored the program to save Medicare $2 billion over the next 10 years

CMS and Nursing Facility VBP

Key NM Medicaid Nursing Facility Facts

bull Medicaid pays for about 14 M NF days per year

bull Medicaid is the primary payer for gt90 of Long Term Care facility days

bull There are only 76 licensed NFs in New Mexico (compared to gt 1000 in California and Texas)

VBP in New Mexico Medicaid

Traditional Medicaid and Other Programs

Medicaid Expansion under the ACA

2774

72262014 1002015 1002016 1002017 952018 942019 93

2020 on 90

NM General Fund

NM General Fund

Federal Government

Federal Government

2014 02015 02016 02017 52018 62019 7

2020 on 10

2019 Medicaid Managed Care Organizations(BCBS Presbyterian Western Skies)

New Mexico

Hospitals

NM Medical Groups

Home Care

Dentists DME Providers

Many Others

Skilled and Long Term Care NFs

$1$260 $1$19 -gt$1$9

Oversimplified View of Health Care Financing through Centennial Care

14 M nursing facility bed days per yearand gt90 LTC bed days

How VBP ldquoWorksrdquo

Centennial Care Timeline

2014 2015 2016 2017

Centennial Care Initiated(112014)

Final Waiver Application CMS

Review and Approval(112017-122018)

Centennial Care 20 Stakeholder Input(102016-62017)

bull Subcommittee of the MAC

bull Tribal Consultation

bull Concept Paper

bull Public meetings

Draft Waiver Application and Public

Comment(92017-112017)

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Only 56 days from today

VBP Requirements in CC 20 RFP

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

Why Implement VBP Programs in Nursing Facilities

bull The Minimum Data Set (MDS) is part of the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified nursing homes

bull Established and refined mid-1990sbull This process provides a comprehensive assessment

of each residents functional capabilities and helps nursing home staff identify health problems

bull ldquoNo new measuresrdquo

Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs

bull HR 4302 the Protecting Access to Medicare Act of 2014legislates a value-based purchasing (VBP) program for skilled nursing facilities (SNFs)

bull Establishes a hospital readmissions reduction program for these providers encouraging SNFs to address potentially avoidable readmissions by establishing an incentive pool for high performers

bull The Congressional Budget Office scored the program to save Medicare $2 billion over the next 10 years

CMS and Nursing Facility VBP

Key NM Medicaid Nursing Facility Facts

bull Medicaid pays for about 14 M NF days per year

bull Medicaid is the primary payer for gt90 of Long Term Care facility days

bull There are only 76 licensed NFs in New Mexico (compared to gt 1000 in California and Texas)

VBP in New Mexico Medicaid

Traditional Medicaid and Other Programs

Medicaid Expansion under the ACA

2774

72262014 1002015 1002016 1002017 952018 942019 93

2020 on 90

NM General Fund

NM General Fund

Federal Government

Federal Government

2014 02015 02016 02017 52018 62019 7

2020 on 10

2019 Medicaid Managed Care Organizations(BCBS Presbyterian Western Skies)

New Mexico

Hospitals

NM Medical Groups

Home Care

Dentists DME Providers

Many Others

Skilled and Long Term Care NFs

$1$260 $1$19 -gt$1$9

Oversimplified View of Health Care Financing through Centennial Care

14 M nursing facility bed days per yearand gt90 LTC bed days

How VBP ldquoWorksrdquo

Centennial Care Timeline

2014 2015 2016 2017

Centennial Care Initiated(112014)

Final Waiver Application CMS

Review and Approval(112017-122018)

Centennial Care 20 Stakeholder Input(102016-62017)

bull Subcommittee of the MAC

bull Tribal Consultation

bull Concept Paper

bull Public meetings

Draft Waiver Application and Public

Comment(92017-112017)

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Only 56 days from today

VBP Requirements in CC 20 RFP

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs

bull HR 4302 the Protecting Access to Medicare Act of 2014legislates a value-based purchasing (VBP) program for skilled nursing facilities (SNFs)

bull Establishes a hospital readmissions reduction program for these providers encouraging SNFs to address potentially avoidable readmissions by establishing an incentive pool for high performers

bull The Congressional Budget Office scored the program to save Medicare $2 billion over the next 10 years

CMS and Nursing Facility VBP

Key NM Medicaid Nursing Facility Facts

bull Medicaid pays for about 14 M NF days per year

bull Medicaid is the primary payer for gt90 of Long Term Care facility days

bull There are only 76 licensed NFs in New Mexico (compared to gt 1000 in California and Texas)

VBP in New Mexico Medicaid

Traditional Medicaid and Other Programs

Medicaid Expansion under the ACA

2774

72262014 1002015 1002016 1002017 952018 942019 93

2020 on 90

NM General Fund

NM General Fund

Federal Government

Federal Government

2014 02015 02016 02017 52018 62019 7

2020 on 10

2019 Medicaid Managed Care Organizations(BCBS Presbyterian Western Skies)

New Mexico

Hospitals

NM Medical Groups

Home Care

Dentists DME Providers

Many Others

Skilled and Long Term Care NFs

$1$260 $1$19 -gt$1$9

Oversimplified View of Health Care Financing through Centennial Care

14 M nursing facility bed days per yearand gt90 LTC bed days

How VBP ldquoWorksrdquo

Centennial Care Timeline

2014 2015 2016 2017

Centennial Care Initiated(112014)

Final Waiver Application CMS

Review and Approval(112017-122018)

Centennial Care 20 Stakeholder Input(102016-62017)

bull Subcommittee of the MAC

bull Tribal Consultation

bull Concept Paper

bull Public meetings

Draft Waiver Application and Public

Comment(92017-112017)

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Only 56 days from today

VBP Requirements in CC 20 RFP

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

CMS and Nursing Facility VBP

Key NM Medicaid Nursing Facility Facts

bull Medicaid pays for about 14 M NF days per year

bull Medicaid is the primary payer for gt90 of Long Term Care facility days

bull There are only 76 licensed NFs in New Mexico (compared to gt 1000 in California and Texas)

VBP in New Mexico Medicaid

Traditional Medicaid and Other Programs

Medicaid Expansion under the ACA

2774

72262014 1002015 1002016 1002017 952018 942019 93

2020 on 90

NM General Fund

NM General Fund

Federal Government

Federal Government

2014 02015 02016 02017 52018 62019 7

2020 on 10

2019 Medicaid Managed Care Organizations(BCBS Presbyterian Western Skies)

New Mexico

Hospitals

NM Medical Groups

Home Care

Dentists DME Providers

Many Others

Skilled and Long Term Care NFs

$1$260 $1$19 -gt$1$9

Oversimplified View of Health Care Financing through Centennial Care

14 M nursing facility bed days per yearand gt90 LTC bed days

How VBP ldquoWorksrdquo

Centennial Care Timeline

2014 2015 2016 2017

Centennial Care Initiated(112014)

Final Waiver Application CMS

Review and Approval(112017-122018)

Centennial Care 20 Stakeholder Input(102016-62017)

bull Subcommittee of the MAC

bull Tribal Consultation

bull Concept Paper

bull Public meetings

Draft Waiver Application and Public

Comment(92017-112017)

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Only 56 days from today

VBP Requirements in CC 20 RFP

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

Key NM Medicaid Nursing Facility Facts

bull Medicaid pays for about 14 M NF days per year

bull Medicaid is the primary payer for gt90 of Long Term Care facility days

bull There are only 76 licensed NFs in New Mexico (compared to gt 1000 in California and Texas)

VBP in New Mexico Medicaid

Traditional Medicaid and Other Programs

Medicaid Expansion under the ACA

2774

72262014 1002015 1002016 1002017 952018 942019 93

2020 on 90

NM General Fund

NM General Fund

Federal Government

Federal Government

2014 02015 02016 02017 52018 62019 7

2020 on 10

2019 Medicaid Managed Care Organizations(BCBS Presbyterian Western Skies)

New Mexico

Hospitals

NM Medical Groups

Home Care

Dentists DME Providers

Many Others

Skilled and Long Term Care NFs

$1$260 $1$19 -gt$1$9

Oversimplified View of Health Care Financing through Centennial Care

14 M nursing facility bed days per yearand gt90 LTC bed days

How VBP ldquoWorksrdquo

Centennial Care Timeline

2014 2015 2016 2017

Centennial Care Initiated(112014)

Final Waiver Application CMS

Review and Approval(112017-122018)

Centennial Care 20 Stakeholder Input(102016-62017)

bull Subcommittee of the MAC

bull Tribal Consultation

bull Concept Paper

bull Public meetings

Draft Waiver Application and Public

Comment(92017-112017)

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Only 56 days from today

VBP Requirements in CC 20 RFP

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

VBP in New Mexico Medicaid

Traditional Medicaid and Other Programs

Medicaid Expansion under the ACA

2774

72262014 1002015 1002016 1002017 952018 942019 93

2020 on 90

NM General Fund

NM General Fund

Federal Government

Federal Government

2014 02015 02016 02017 52018 62019 7

2020 on 10

2019 Medicaid Managed Care Organizations(BCBS Presbyterian Western Skies)

New Mexico

Hospitals

NM Medical Groups

Home Care

Dentists DME Providers

Many Others

Skilled and Long Term Care NFs

$1$260 $1$19 -gt$1$9

Oversimplified View of Health Care Financing through Centennial Care

14 M nursing facility bed days per yearand gt90 LTC bed days

How VBP ldquoWorksrdquo

Centennial Care Timeline

2014 2015 2016 2017

Centennial Care Initiated(112014)

Final Waiver Application CMS

Review and Approval(112017-122018)

Centennial Care 20 Stakeholder Input(102016-62017)

bull Subcommittee of the MAC

bull Tribal Consultation

bull Concept Paper

bull Public meetings

Draft Waiver Application and Public

Comment(92017-112017)

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Only 56 days from today

VBP Requirements in CC 20 RFP

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

Traditional Medicaid and Other Programs

Medicaid Expansion under the ACA

2774

72262014 1002015 1002016 1002017 952018 942019 93

2020 on 90

NM General Fund

NM General Fund

Federal Government

Federal Government

2014 02015 02016 02017 52018 62019 7

2020 on 10

2019 Medicaid Managed Care Organizations(BCBS Presbyterian Western Skies)

New Mexico

Hospitals

NM Medical Groups

Home Care

Dentists DME Providers

Many Others

Skilled and Long Term Care NFs

$1$260 $1$19 -gt$1$9

Oversimplified View of Health Care Financing through Centennial Care

14 M nursing facility bed days per yearand gt90 LTC bed days

How VBP ldquoWorksrdquo

Centennial Care Timeline

2014 2015 2016 2017

Centennial Care Initiated(112014)

Final Waiver Application CMS

Review and Approval(112017-122018)

Centennial Care 20 Stakeholder Input(102016-62017)

bull Subcommittee of the MAC

bull Tribal Consultation

bull Concept Paper

bull Public meetings

Draft Waiver Application and Public

Comment(92017-112017)

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Only 56 days from today

VBP Requirements in CC 20 RFP

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

How VBP ldquoWorksrdquo

Centennial Care Timeline

2014 2015 2016 2017

Centennial Care Initiated(112014)

Final Waiver Application CMS

Review and Approval(112017-122018)

Centennial Care 20 Stakeholder Input(102016-62017)

bull Subcommittee of the MAC

bull Tribal Consultation

bull Concept Paper

bull Public meetings

Draft Waiver Application and Public

Comment(92017-112017)

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Only 56 days from today

VBP Requirements in CC 20 RFP

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

Centennial Care Timeline

2014 2015 2016 2017

Centennial Care Initiated(112014)

Final Waiver Application CMS

Review and Approval(112017-122018)

Centennial Care 20 Stakeholder Input(102016-62017)

bull Subcommittee of the MAC

bull Tribal Consultation

bull Concept Paper

bull Public meetings

Draft Waiver Application and Public

Comment(92017-112017)

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Only 56 days from today

VBP Requirements in CC 20 RFP

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

VBP Requirements in CC 20 RFP

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

Nursing Facility-Specific VBP Programsin Other States (California Texas)

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

Example 1 California2016-17 Point Allocation by Quality Measure

httpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf

Points Allocation Quality Measure

Pressure Ulcers Long Stay Measure 11111

Physical Restraints Long-Stay 11111

Influenza Vaccination Short Stay 555575

Pneumococcal Vaccination Short Stay 555575

Urinary Tract Infection Long Stay 11111

Control of BowelBladder Long Stay 11111

Self-Report Pain Short Stay 555575

Self-Report Pain Long-Stay 555575

Activities of Daily Living Long-Stay 11111

Staff Retention 11111

30 Day All-Cause Readmission 11111

Total 100

2013 Data California Quality and Accountability Supplemental Payments (QASP)

Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf

Example 2 Texas QIPP Program

bull The Quality Incentive Payment Program (QIPP) encourages nursing facilities to improve the quality and innovation of their services using the Centers for Medicare amp Medicaid (CMS) 5-star rating system as its measure of success for the following 4 quality measuresndash High-risk long-stay residents with pressure ulcersndash Percent of residents who received an antipsychotic medication (long-stay)ndash Residents experiencing one or more falls with major injuryndash Residents who were physically restrained

bull Credit given for both meeting targets and also for improvementbull Payout of $20 per Medicaid resident per day in initial phase of program

Source httpshhstexasgovserviceshealthmedicaid-chipprovider-informationquality-incentive-payment-program-nursing-homes

Example 2 Texas QIPP Program

bull The Quality Incentive Payment Program (QIPP) encourages nursing facilities to improve the quality and innovation of their services using the Centers for Medicare amp Medicaid (CMS) 5-star rating system as its measure of success for the following 4 quality measuresndash High-risk long-stay residents with pressure ulcersndash Percent of residents who received an antipsychotic medication (long-stay)ndash Residents experiencing one or more falls with major injuryndash Residents who were physically restrained

bull Credit given for both meeting targets and also for improvementbull Payout of $20 per Medicaid resident per day in initial phase of program

Source httpshhstexasgovserviceshealthmedicaid-chipprovider-informationquality-incentive-payment-program-nursing-homes

Mission To democratize knowledge and get best practice care to underserved people all over the world

Project ECHO(Extension for Community Health Outcomes)

Est 2003

Supported by New Mexico Department of Health Agency for Health Research and Quality New Mexico Legislature Robert Wood Johnson Foundation GE Foundation Helmsley Trust Bristol Myers Squibb Foundation Merck Foundation and New Mexico Medicaid

Moving Knowledge Instead of Patients

Goal to improve the lives of 1 billion people by 2025

httpechounmedu

Moving Knowledge Instead of Patients

Goal to improve the lives of 1 billion people by 2025

httpechounmedu

The ECHO Modeltrade

bull Use Technology to leverage scarce resources

bull Share ldquobest practicesrdquo to reduce disparities

bull Case-based learning to master complexity

bull Web-based database to monitor outcomes

Arora S et al Acad Med 2007 Feb82(2)154-60

Are you part of the ECHO

Are you part of the ECHO

Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program

in New Mexico

The Structure

Quality Improvement

Hospitalization Avoidance

MCOs VBP

Behavioral Health

Community Advisory Board

Project Leadership Group

Provider Advisory Group

Other Metrics

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Meet with Medicaidbull Research NF VBP

programs in other states

QIHA

VBP

Name Title OrganizationCrystal Hodges Deputy Bureau Chief LTSSB HSDMADCynthia Olivas Nurse Manager ECHO InstituteDavid Scrase Medical Director UNM GCOE Internal MedElizabeth Clewett Director of Replication ECHO InstituteErica Archuleta Physical Health Unit Mgr Centennial Care Contracts Bureau HSDMADJoseph Foxhood Assistant Director Uptown GenesisKarisa Risa Berry Executive Director San Juan Center in Farmington GenesisKevin Traylor Executive Director Uptown GenesisMarisa Marquez Project ECHO NM Operations Student ECHO InstituteMartha Carvour University of New Mexico Health Sciences Center ID Fellow Pat Whitacre Director of Quality and Clinical Services NM Health Care AssnRemona Benally Project Manager HealthInsight New MexicoShannon Cupka Project Manager HealthInsight New MexicoSteven Littlehale Chief Clinical Office and Executive VP Point RightEmilee Brodie Program Specialist Clinic Coordination ECHO InstituteTallie Tolen Bureau Chief Long Term Services and Supports Bureau (LTSSB)HSDMADThomas Kim Senior VP Medical Affairs GenesisTracy Smith Program Manager Quality Improvement Initiatives ECHO InstituteVanessa Rodriguez Center Nurse Executive Genesis Healthcare at Sandia Ridge Genesis

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

Quality Measure Group 2013 2014 2015 2016 2017 Gap RankSS Pneumonia Vac NM 6831593 6443415 6739485 6834131 6969712 1341253 1SS Influenza Vac NM 7247877 6772346 6671301 6680579 7052135 1050172 2SS Pain NM 2326298 2305328 2409461 2399083 2269283 9028904 3LS Pneumonia Vac NM 8064335 7914562 7956349 8289466 8575912 8385886 4LS Pain NM 9452523 8633543 1144037 1135775 9733362 4161743 5LS ADL NM 1911791 1922245 1844584 1954841 1854308 3566242 6LS Influenza Vac NM 8627691 8887254 8717901 9145866 9261725 2315015 7LS Mobility Worse NM 198982 2141174 2050577 2292328 8SS Outpatient ED Visits NM 1389574 1337558 1335203 1494649 9LS PU NM 6347849 6174637 6079916 6209895 6727337 1124526 10LS Antipsychotic NM 191337 1723704 1645566 1715094 1670944 1026828 11LS Catheter NM 3301297 2943718 3512884 3313439 2530768 0665996 12SS Antipsychotic NM 2904668 2460702 2490567 2531788 2314779 0326286 13SS PU NM 0992341 0791212 1503379 1272956 1008694 0132106 14LS Weight Loss NM 7161366 6298023 7234606 7107744 7179254 0096303 15LS Falls w Injury NM 3680669 3858533 3988173 4239733 3461082 0087468 16LS Restraints NM 072376 0583683 0601877 0511199 0320772 -011002 17LS Depression NM 34918 3007546 2934389 3838857 468194 -018908 18LS UTI NM 5247255 4651044 3981836 3072016 289301 -076767 19SS Rehospitalization NM 201547 2026018 2021202 -088745 20SS Successful Dis to Comm NM 5180244 5973186 5967146 -263949 21SS Functional Impr NM 6128979 6350563 6387649 -359513 22

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

MCO VBP GroupName OrganizationQuinn Glenzinski Blue Cross Blue Shield of New MexicoDr Wei-Ann Bay Blue Cross Blue Shield of New MexicoSusan Dezavelle Blue Cross Blue Shield of New MexicoHolly Lawrence Blue Cross Blue Shield of New MexicoEric Cibak Blue Cross Blue Shield of New MexicoMichael Archuleta Blue Cross Blue Shield of New MexicoArlene Britt Blue Cross Blue Shield of New MexicoMary Eden Presbyterian Health PlanJordan Erp Presbyterian Health PlanHeather Ingram Presbyterian Health PlanDeb Revard Presbyterian Health PlanNathan Cogburn Western Sky Community CareDr Latha Shankar Western Sky Community CareMessina Martinez Western Sky Community CareRosanna Nelson Western Sky Community CareMarta Larson Western Sky Community CareDr David Scrase HSDEstevan Baca HSDErica Archuleta HSD

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

NAME OF FACILITY LOCATION OF FACILITY

Rio Rancho Center 4210 Sabana Grande SE Rio Rancho

Las Palomas Center 8100 Palomas NE ABQ 87109

The Rehabilitation of ABQ 5900 Forest Hills Dr NE ABQ 87109

Albuquerque Hts Healthcare 103 Hospital Loop NE ABQ 87109

Ladera Center 5901 Ouray Road NW ABQ 87120

Skies Healthcare 9150 McMahon NW ABQ 87114

Uptown Rehabilitation Center 7900 Constitution Ave NE ABQ 87110

Sandia Ridge Center 2216 Lester Dr NE ABQ 87112

Canyon Transitional Rehab 10101 Lagrima de Oro NE ABQ 87111

Genesis Bear Canyon 5123 Juan Tabo Blvd NE ABQ 87111

San Juan Center 806 West Maple Street Farmington 87401

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Provider Advisory GroupName OrganizationJason Espinoza New Mexico Health Care AssociationKelley Whitaker FundamentalPat Whitacre New Mexico Health Care AssociationLashuan Bethea Genesis HealthCareLori Greer-Harris Genesis HealthCareJerry Cahill Genesis HealthCareRayna Fagus Eduro HealthcareBrian Falkler FundamentalSara Farmer Genesis HealthCareTerry Harman Genesis HealthCareMichael Jacobs FundamentalJody Knox Lakeview Christian HomePete Looker South Valley Care CenterCynthia Myers Genesis HealthCareHeidi Trimble FundamentalLillian Werntz Genesis HealthCareHorace Winchester OnPointeIrene Torres Genesis HealthCareFran Chapman Fundamental

MCO Basic Principles that Should Drive a NM NF VBP Program (91418)

bull ldquoOne stop shoppingrdquo - a single programbull KPIs metrics must be standardized (national data)bull Leverage best practices in other statesbull Co-brandingbull Provider ownershipbuy-in contribute to design of programbull Provider centric (stratified by level of providers)bull All providers have the opportunity to ldquowinrdquo and there are early

winsbull Supports other goals (eg community reintegration)bull Based on Medicaid membersdatabull Financial component has to be significant enough to be an

incentivebull Rewards for both meeting targets and improvementbull Actuarially soundbull Sustainable over the long runbull Quarterly or semi-annual paymentsbull Some metric for resident satisfactionbull Consider special situations (eg behavioral health facilities)bull Figure out DSNIPbull Transparent feedback to providersbull Performance scorecardbull Payouts based on aggregate membershipbull Patient centered care (continuity)bull Include all stakeholders in this processbull Care is coordinated and integrated to address both PH and BH

and Social Determinates of Health (SDoH)bull Financial drivers are aligned with the populationrsquos needbull Have data management strategybull Quality measures should be understandable validreliable

achievable fair and worth the effort

Common Principles for both MCOs and Provider Advisory Group

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull All providers have the opportunity to ldquowinrdquo and there are early wins

bull Payouts based on Medicaid bed days (volume in each facility)

bull Quarterly or semi-annual paymentsbull Specialty facility special considerations

(eg behavioral health and wound care facilities)

bull Transparent feedback to providers

Provider Advisory Guiding Principles(101918)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Prospective and fair method for setting (and resetting) targets over time

bull Specialty facility special considerations (psych and wound care facilities)

bull More frequent payouts (eg every 3 months)bull Consideration in metric selection regarding time frames

(eg fall with injury may continue for 270 days)bull Possible for everyone to ldquowinrdquobull Opportunity to address behavioral and opioid patient

population (will discuss how later)bull Tiered system to provide extra reward for challenging

patients but need to be sure training and ability to provide care is in place

bull Defined conditions of participation (TBD)bull Need to address the DOH-related regulatory issues

related to taking on BH patientsbull Voluntarybull Transparent data ndash clearly publishedbull Need to evaluate retroactive changes in membershipbull Payouts based on Medicaid bed days (volume in each

facility)

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

List of topics for prioritization for Oct-DecMedication reconciliationProtocol development ndash first 24 hoursAdjunctive medication treatments for painSubstance use disorder (opioids)Coping and painRisk assessment toolsCommunication strategies Discharge data sets ndash what is out thereInfection control 101UTIs and protocol for ordering UAs

Medicaid QIHA ECHO Session October 26Standard Agendabull Welcome amp Updatesbull ldquoCaserdquo Discussion

ndash Facility presents challengendash Structured facilitated discussion

bull Clarifying questions ndash community facultybull Recommendations ndash community faculty

bull Brief Lecture (~10-15 minutes)bull ldquoCaserdquo Discussionbull Quality Toolbull Wrap Up

TIME ITEM LEADER GOAL1000ndash15 Welcome Tracy Smith BA Set stage for meeting

1015-55 Case Discussion 1 ndash San Juan

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1055-1125 Communication Strategies SBAR Tool

Marissa Hotze RN David Scrase MD

Discuss the importance of communication review late night scenarios and learn the SBAR tool

1125-55 Case Discussion 2 ndash Heights

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1150-55 Quality Tool Run Chart Rules

Tracy Smith BA Develop shared understanding of quality tools

1155-1200 Wrap up Tracy Smith BA Share in chat What went well What could we improve on How good of a job did our group do including everyone

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

The Structure

Quality Improvement

Hospitalization Avoidance

MCOs VBP

Behavioral Health

Community Advisory Board

Project Leadership Group

Provider Advisory Group

Other Metrics

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Meet with Medicaidbull Research NF VBP

programs in other states

QIHA

VBP

Name Title OrganizationCrystal Hodges Deputy Bureau Chief LTSSB HSDMADCynthia Olivas Nurse Manager ECHO InstituteDavid Scrase Medical Director UNM GCOE Internal MedElizabeth Clewett Director of Replication ECHO InstituteErica Archuleta Physical Health Unit Mgr Centennial Care Contracts Bureau HSDMADJoseph Foxhood Assistant Director Uptown GenesisKarisa Risa Berry Executive Director San Juan Center in Farmington GenesisKevin Traylor Executive Director Uptown GenesisMarisa Marquez Project ECHO NM Operations Student ECHO InstituteMartha Carvour University of New Mexico Health Sciences Center ID Fellow Pat Whitacre Director of Quality and Clinical Services NM Health Care AssnRemona Benally Project Manager HealthInsight New MexicoShannon Cupka Project Manager HealthInsight New MexicoSteven Littlehale Chief Clinical Office and Executive VP Point RightEmilee Brodie Program Specialist Clinic Coordination ECHO InstituteTallie Tolen Bureau Chief Long Term Services and Supports Bureau (LTSSB)HSDMADThomas Kim Senior VP Medical Affairs GenesisTracy Smith Program Manager Quality Improvement Initiatives ECHO InstituteVanessa Rodriguez Center Nurse Executive Genesis Healthcare at Sandia Ridge Genesis

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

Quality Measure Group 2013 2014 2015 2016 2017 Gap RankSS Pneumonia Vac NM 6831593 6443415 6739485 6834131 6969712 1341253 1SS Influenza Vac NM 7247877 6772346 6671301 6680579 7052135 1050172 2SS Pain NM 2326298 2305328 2409461 2399083 2269283 9028904 3LS Pneumonia Vac NM 8064335 7914562 7956349 8289466 8575912 8385886 4LS Pain NM 9452523 8633543 1144037 1135775 9733362 4161743 5LS ADL NM 1911791 1922245 1844584 1954841 1854308 3566242 6LS Influenza Vac NM 8627691 8887254 8717901 9145866 9261725 2315015 7LS Mobility Worse NM 198982 2141174 2050577 2292328 8SS Outpatient ED Visits NM 1389574 1337558 1335203 1494649 9LS PU NM 6347849 6174637 6079916 6209895 6727337 1124526 10LS Antipsychotic NM 191337 1723704 1645566 1715094 1670944 1026828 11LS Catheter NM 3301297 2943718 3512884 3313439 2530768 0665996 12SS Antipsychotic NM 2904668 2460702 2490567 2531788 2314779 0326286 13SS PU NM 0992341 0791212 1503379 1272956 1008694 0132106 14LS Weight Loss NM 7161366 6298023 7234606 7107744 7179254 0096303 15LS Falls w Injury NM 3680669 3858533 3988173 4239733 3461082 0087468 16LS Restraints NM 072376 0583683 0601877 0511199 0320772 -011002 17LS Depression NM 34918 3007546 2934389 3838857 468194 -018908 18LS UTI NM 5247255 4651044 3981836 3072016 289301 -076767 19SS Rehospitalization NM 201547 2026018 2021202 -088745 20SS Successful Dis to Comm NM 5180244 5973186 5967146 -263949 21SS Functional Impr NM 6128979 6350563 6387649 -359513 22

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

MCO VBP GroupName OrganizationQuinn Glenzinski Blue Cross Blue Shield of New MexicoDr Wei-Ann Bay Blue Cross Blue Shield of New MexicoSusan Dezavelle Blue Cross Blue Shield of New MexicoHolly Lawrence Blue Cross Blue Shield of New MexicoEric Cibak Blue Cross Blue Shield of New MexicoMichael Archuleta Blue Cross Blue Shield of New MexicoArlene Britt Blue Cross Blue Shield of New MexicoMary Eden Presbyterian Health PlanJordan Erp Presbyterian Health PlanHeather Ingram Presbyterian Health PlanDeb Revard Presbyterian Health PlanNathan Cogburn Western Sky Community CareDr Latha Shankar Western Sky Community CareMessina Martinez Western Sky Community CareRosanna Nelson Western Sky Community CareMarta Larson Western Sky Community CareDr David Scrase HSDEstevan Baca HSDErica Archuleta HSD

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

NAME OF FACILITY LOCATION OF FACILITY

Rio Rancho Center 4210 Sabana Grande SE Rio Rancho

Las Palomas Center 8100 Palomas NE ABQ 87109

The Rehabilitation of ABQ 5900 Forest Hills Dr NE ABQ 87109

Albuquerque Hts Healthcare 103 Hospital Loop NE ABQ 87109

Ladera Center 5901 Ouray Road NW ABQ 87120

Skies Healthcare 9150 McMahon NW ABQ 87114

Uptown Rehabilitation Center 7900 Constitution Ave NE ABQ 87110

Sandia Ridge Center 2216 Lester Dr NE ABQ 87112

Canyon Transitional Rehab 10101 Lagrima de Oro NE ABQ 87111

Genesis Bear Canyon 5123 Juan Tabo Blvd NE ABQ 87111

San Juan Center 806 West Maple Street Farmington 87401

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Provider Advisory GroupName OrganizationJason Espinoza New Mexico Health Care AssociationKelley Whitaker FundamentalPat Whitacre New Mexico Health Care AssociationLashuan Bethea Genesis HealthCareLori Greer-Harris Genesis HealthCareJerry Cahill Genesis HealthCareRayna Fagus Eduro HealthcareBrian Falkler FundamentalSara Farmer Genesis HealthCareTerry Harman Genesis HealthCareMichael Jacobs FundamentalJody Knox Lakeview Christian HomePete Looker South Valley Care CenterCynthia Myers Genesis HealthCareHeidi Trimble FundamentalLillian Werntz Genesis HealthCareHorace Winchester OnPointeIrene Torres Genesis HealthCareFran Chapman Fundamental

MCO Basic Principles that Should Drive a NM NF VBP Program (91418)

bull ldquoOne stop shoppingrdquo - a single programbull KPIs metrics must be standardized (national data)bull Leverage best practices in other statesbull Co-brandingbull Provider ownershipbuy-in contribute to design of programbull Provider centric (stratified by level of providers)bull All providers have the opportunity to ldquowinrdquo and there are early

winsbull Supports other goals (eg community reintegration)bull Based on Medicaid membersdatabull Financial component has to be significant enough to be an

incentivebull Rewards for both meeting targets and improvementbull Actuarially soundbull Sustainable over the long runbull Quarterly or semi-annual paymentsbull Some metric for resident satisfactionbull Consider special situations (eg behavioral health facilities)bull Figure out DSNIPbull Transparent feedback to providersbull Performance scorecardbull Payouts based on aggregate membershipbull Patient centered care (continuity)bull Include all stakeholders in this processbull Care is coordinated and integrated to address both PH and BH

and Social Determinates of Health (SDoH)bull Financial drivers are aligned with the populationrsquos needbull Have data management strategybull Quality measures should be understandable validreliable

achievable fair and worth the effort

Common Principles for both MCOs and Provider Advisory Group

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull All providers have the opportunity to ldquowinrdquo and there are early wins

bull Payouts based on Medicaid bed days (volume in each facility)

bull Quarterly or semi-annual paymentsbull Specialty facility special considerations

(eg behavioral health and wound care facilities)

bull Transparent feedback to providers

Provider Advisory Guiding Principles(101918)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Prospective and fair method for setting (and resetting) targets over time

bull Specialty facility special considerations (psych and wound care facilities)

bull More frequent payouts (eg every 3 months)bull Consideration in metric selection regarding time frames

(eg fall with injury may continue for 270 days)bull Possible for everyone to ldquowinrdquobull Opportunity to address behavioral and opioid patient

population (will discuss how later)bull Tiered system to provide extra reward for challenging

patients but need to be sure training and ability to provide care is in place

bull Defined conditions of participation (TBD)bull Need to address the DOH-related regulatory issues

related to taking on BH patientsbull Voluntarybull Transparent data ndash clearly publishedbull Need to evaluate retroactive changes in membershipbull Payouts based on Medicaid bed days (volume in each

facility)

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

List of topics for prioritization for Oct-DecMedication reconciliationProtocol development ndash first 24 hoursAdjunctive medication treatments for painSubstance use disorder (opioids)Coping and painRisk assessment toolsCommunication strategies Discharge data sets ndash what is out thereInfection control 101UTIs and protocol for ordering UAs

Medicaid QIHA ECHO Session October 26Standard Agendabull Welcome amp Updatesbull ldquoCaserdquo Discussion

ndash Facility presents challengendash Structured facilitated discussion

bull Clarifying questions ndash community facultybull Recommendations ndash community faculty

bull Brief Lecture (~10-15 minutes)bull ldquoCaserdquo Discussionbull Quality Toolbull Wrap Up

TIME ITEM LEADER GOAL1000ndash15 Welcome Tracy Smith BA Set stage for meeting

1015-55 Case Discussion 1 ndash San Juan

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1055-1125 Communication Strategies SBAR Tool

Marissa Hotze RN David Scrase MD

Discuss the importance of communication review late night scenarios and learn the SBAR tool

1125-55 Case Discussion 2 ndash Heights

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1150-55 Quality Tool Run Chart Rules

Tracy Smith BA Develop shared understanding of quality tools

1155-1200 Wrap up Tracy Smith BA Share in chat What went well What could we improve on How good of a job did our group do including everyone

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Meet with Medicaidbull Research NF VBP

programs in other states

QIHA

VBP

Name Title OrganizationCrystal Hodges Deputy Bureau Chief LTSSB HSDMADCynthia Olivas Nurse Manager ECHO InstituteDavid Scrase Medical Director UNM GCOE Internal MedElizabeth Clewett Director of Replication ECHO InstituteErica Archuleta Physical Health Unit Mgr Centennial Care Contracts Bureau HSDMADJoseph Foxhood Assistant Director Uptown GenesisKarisa Risa Berry Executive Director San Juan Center in Farmington GenesisKevin Traylor Executive Director Uptown GenesisMarisa Marquez Project ECHO NM Operations Student ECHO InstituteMartha Carvour University of New Mexico Health Sciences Center ID Fellow Pat Whitacre Director of Quality and Clinical Services NM Health Care AssnRemona Benally Project Manager HealthInsight New MexicoShannon Cupka Project Manager HealthInsight New MexicoSteven Littlehale Chief Clinical Office and Executive VP Point RightEmilee Brodie Program Specialist Clinic Coordination ECHO InstituteTallie Tolen Bureau Chief Long Term Services and Supports Bureau (LTSSB)HSDMADThomas Kim Senior VP Medical Affairs GenesisTracy Smith Program Manager Quality Improvement Initiatives ECHO InstituteVanessa Rodriguez Center Nurse Executive Genesis Healthcare at Sandia Ridge Genesis

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

Quality Measure Group 2013 2014 2015 2016 2017 Gap RankSS Pneumonia Vac NM 6831593 6443415 6739485 6834131 6969712 1341253 1SS Influenza Vac NM 7247877 6772346 6671301 6680579 7052135 1050172 2SS Pain NM 2326298 2305328 2409461 2399083 2269283 9028904 3LS Pneumonia Vac NM 8064335 7914562 7956349 8289466 8575912 8385886 4LS Pain NM 9452523 8633543 1144037 1135775 9733362 4161743 5LS ADL NM 1911791 1922245 1844584 1954841 1854308 3566242 6LS Influenza Vac NM 8627691 8887254 8717901 9145866 9261725 2315015 7LS Mobility Worse NM 198982 2141174 2050577 2292328 8SS Outpatient ED Visits NM 1389574 1337558 1335203 1494649 9LS PU NM 6347849 6174637 6079916 6209895 6727337 1124526 10LS Antipsychotic NM 191337 1723704 1645566 1715094 1670944 1026828 11LS Catheter NM 3301297 2943718 3512884 3313439 2530768 0665996 12SS Antipsychotic NM 2904668 2460702 2490567 2531788 2314779 0326286 13SS PU NM 0992341 0791212 1503379 1272956 1008694 0132106 14LS Weight Loss NM 7161366 6298023 7234606 7107744 7179254 0096303 15LS Falls w Injury NM 3680669 3858533 3988173 4239733 3461082 0087468 16LS Restraints NM 072376 0583683 0601877 0511199 0320772 -011002 17LS Depression NM 34918 3007546 2934389 3838857 468194 -018908 18LS UTI NM 5247255 4651044 3981836 3072016 289301 -076767 19SS Rehospitalization NM 201547 2026018 2021202 -088745 20SS Successful Dis to Comm NM 5180244 5973186 5967146 -263949 21SS Functional Impr NM 6128979 6350563 6387649 -359513 22

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

MCO VBP GroupName OrganizationQuinn Glenzinski Blue Cross Blue Shield of New MexicoDr Wei-Ann Bay Blue Cross Blue Shield of New MexicoSusan Dezavelle Blue Cross Blue Shield of New MexicoHolly Lawrence Blue Cross Blue Shield of New MexicoEric Cibak Blue Cross Blue Shield of New MexicoMichael Archuleta Blue Cross Blue Shield of New MexicoArlene Britt Blue Cross Blue Shield of New MexicoMary Eden Presbyterian Health PlanJordan Erp Presbyterian Health PlanHeather Ingram Presbyterian Health PlanDeb Revard Presbyterian Health PlanNathan Cogburn Western Sky Community CareDr Latha Shankar Western Sky Community CareMessina Martinez Western Sky Community CareRosanna Nelson Western Sky Community CareMarta Larson Western Sky Community CareDr David Scrase HSDEstevan Baca HSDErica Archuleta HSD

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

NAME OF FACILITY LOCATION OF FACILITY

Rio Rancho Center 4210 Sabana Grande SE Rio Rancho

Las Palomas Center 8100 Palomas NE ABQ 87109

The Rehabilitation of ABQ 5900 Forest Hills Dr NE ABQ 87109

Albuquerque Hts Healthcare 103 Hospital Loop NE ABQ 87109

Ladera Center 5901 Ouray Road NW ABQ 87120

Skies Healthcare 9150 McMahon NW ABQ 87114

Uptown Rehabilitation Center 7900 Constitution Ave NE ABQ 87110

Sandia Ridge Center 2216 Lester Dr NE ABQ 87112

Canyon Transitional Rehab 10101 Lagrima de Oro NE ABQ 87111

Genesis Bear Canyon 5123 Juan Tabo Blvd NE ABQ 87111

San Juan Center 806 West Maple Street Farmington 87401

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Provider Advisory GroupName OrganizationJason Espinoza New Mexico Health Care AssociationKelley Whitaker FundamentalPat Whitacre New Mexico Health Care AssociationLashuan Bethea Genesis HealthCareLori Greer-Harris Genesis HealthCareJerry Cahill Genesis HealthCareRayna Fagus Eduro HealthcareBrian Falkler FundamentalSara Farmer Genesis HealthCareTerry Harman Genesis HealthCareMichael Jacobs FundamentalJody Knox Lakeview Christian HomePete Looker South Valley Care CenterCynthia Myers Genesis HealthCareHeidi Trimble FundamentalLillian Werntz Genesis HealthCareHorace Winchester OnPointeIrene Torres Genesis HealthCareFran Chapman Fundamental

MCO Basic Principles that Should Drive a NM NF VBP Program (91418)

bull ldquoOne stop shoppingrdquo - a single programbull KPIs metrics must be standardized (national data)bull Leverage best practices in other statesbull Co-brandingbull Provider ownershipbuy-in contribute to design of programbull Provider centric (stratified by level of providers)bull All providers have the opportunity to ldquowinrdquo and there are early

winsbull Supports other goals (eg community reintegration)bull Based on Medicaid membersdatabull Financial component has to be significant enough to be an

incentivebull Rewards for both meeting targets and improvementbull Actuarially soundbull Sustainable over the long runbull Quarterly or semi-annual paymentsbull Some metric for resident satisfactionbull Consider special situations (eg behavioral health facilities)bull Figure out DSNIPbull Transparent feedback to providersbull Performance scorecardbull Payouts based on aggregate membershipbull Patient centered care (continuity)bull Include all stakeholders in this processbull Care is coordinated and integrated to address both PH and BH

and Social Determinates of Health (SDoH)bull Financial drivers are aligned with the populationrsquos needbull Have data management strategybull Quality measures should be understandable validreliable

achievable fair and worth the effort

Common Principles for both MCOs and Provider Advisory Group

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull All providers have the opportunity to ldquowinrdquo and there are early wins

bull Payouts based on Medicaid bed days (volume in each facility)

bull Quarterly or semi-annual paymentsbull Specialty facility special considerations

(eg behavioral health and wound care facilities)

bull Transparent feedback to providers

Provider Advisory Guiding Principles(101918)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Prospective and fair method for setting (and resetting) targets over time

bull Specialty facility special considerations (psych and wound care facilities)

bull More frequent payouts (eg every 3 months)bull Consideration in metric selection regarding time frames

(eg fall with injury may continue for 270 days)bull Possible for everyone to ldquowinrdquobull Opportunity to address behavioral and opioid patient

population (will discuss how later)bull Tiered system to provide extra reward for challenging

patients but need to be sure training and ability to provide care is in place

bull Defined conditions of participation (TBD)bull Need to address the DOH-related regulatory issues

related to taking on BH patientsbull Voluntarybull Transparent data ndash clearly publishedbull Need to evaluate retroactive changes in membershipbull Payouts based on Medicaid bed days (volume in each

facility)

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

List of topics for prioritization for Oct-DecMedication reconciliationProtocol development ndash first 24 hoursAdjunctive medication treatments for painSubstance use disorder (opioids)Coping and painRisk assessment toolsCommunication strategies Discharge data sets ndash what is out thereInfection control 101UTIs and protocol for ordering UAs

Medicaid QIHA ECHO Session October 26Standard Agendabull Welcome amp Updatesbull ldquoCaserdquo Discussion

ndash Facility presents challengendash Structured facilitated discussion

bull Clarifying questions ndash community facultybull Recommendations ndash community faculty

bull Brief Lecture (~10-15 minutes)bull ldquoCaserdquo Discussionbull Quality Toolbull Wrap Up

TIME ITEM LEADER GOAL1000ndash15 Welcome Tracy Smith BA Set stage for meeting

1015-55 Case Discussion 1 ndash San Juan

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1055-1125 Communication Strategies SBAR Tool

Marissa Hotze RN David Scrase MD

Discuss the importance of communication review late night scenarios and learn the SBAR tool

1125-55 Case Discussion 2 ndash Heights

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1150-55 Quality Tool Run Chart Rules

Tracy Smith BA Develop shared understanding of quality tools

1155-1200 Wrap up Tracy Smith BA Share in chat What went well What could we improve on How good of a job did our group do including everyone

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

Quality Measure Group 2013 2014 2015 2016 2017 Gap RankSS Pneumonia Vac NM 6831593 6443415 6739485 6834131 6969712 1341253 1SS Influenza Vac NM 7247877 6772346 6671301 6680579 7052135 1050172 2SS Pain NM 2326298 2305328 2409461 2399083 2269283 9028904 3LS Pneumonia Vac NM 8064335 7914562 7956349 8289466 8575912 8385886 4LS Pain NM 9452523 8633543 1144037 1135775 9733362 4161743 5LS ADL NM 1911791 1922245 1844584 1954841 1854308 3566242 6LS Influenza Vac NM 8627691 8887254 8717901 9145866 9261725 2315015 7LS Mobility Worse NM 198982 2141174 2050577 2292328 8SS Outpatient ED Visits NM 1389574 1337558 1335203 1494649 9LS PU NM 6347849 6174637 6079916 6209895 6727337 1124526 10LS Antipsychotic NM 191337 1723704 1645566 1715094 1670944 1026828 11LS Catheter NM 3301297 2943718 3512884 3313439 2530768 0665996 12SS Antipsychotic NM 2904668 2460702 2490567 2531788 2314779 0326286 13SS PU NM 0992341 0791212 1503379 1272956 1008694 0132106 14LS Weight Loss NM 7161366 6298023 7234606 7107744 7179254 0096303 15LS Falls w Injury NM 3680669 3858533 3988173 4239733 3461082 0087468 16LS Restraints NM 072376 0583683 0601877 0511199 0320772 -011002 17LS Depression NM 34918 3007546 2934389 3838857 468194 -018908 18LS UTI NM 5247255 4651044 3981836 3072016 289301 -076767 19SS Rehospitalization NM 201547 2026018 2021202 -088745 20SS Successful Dis to Comm NM 5180244 5973186 5967146 -263949 21SS Functional Impr NM 6128979 6350563 6387649 -359513 22

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

MCO VBP GroupName OrganizationQuinn Glenzinski Blue Cross Blue Shield of New MexicoDr Wei-Ann Bay Blue Cross Blue Shield of New MexicoSusan Dezavelle Blue Cross Blue Shield of New MexicoHolly Lawrence Blue Cross Blue Shield of New MexicoEric Cibak Blue Cross Blue Shield of New MexicoMichael Archuleta Blue Cross Blue Shield of New MexicoArlene Britt Blue Cross Blue Shield of New MexicoMary Eden Presbyterian Health PlanJordan Erp Presbyterian Health PlanHeather Ingram Presbyterian Health PlanDeb Revard Presbyterian Health PlanNathan Cogburn Western Sky Community CareDr Latha Shankar Western Sky Community CareMessina Martinez Western Sky Community CareRosanna Nelson Western Sky Community CareMarta Larson Western Sky Community CareDr David Scrase HSDEstevan Baca HSDErica Archuleta HSD

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

NAME OF FACILITY LOCATION OF FACILITY

Rio Rancho Center 4210 Sabana Grande SE Rio Rancho

Las Palomas Center 8100 Palomas NE ABQ 87109

The Rehabilitation of ABQ 5900 Forest Hills Dr NE ABQ 87109

Albuquerque Hts Healthcare 103 Hospital Loop NE ABQ 87109

Ladera Center 5901 Ouray Road NW ABQ 87120

Skies Healthcare 9150 McMahon NW ABQ 87114

Uptown Rehabilitation Center 7900 Constitution Ave NE ABQ 87110

Sandia Ridge Center 2216 Lester Dr NE ABQ 87112

Canyon Transitional Rehab 10101 Lagrima de Oro NE ABQ 87111

Genesis Bear Canyon 5123 Juan Tabo Blvd NE ABQ 87111

San Juan Center 806 West Maple Street Farmington 87401

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Provider Advisory GroupName OrganizationJason Espinoza New Mexico Health Care AssociationKelley Whitaker FundamentalPat Whitacre New Mexico Health Care AssociationLashuan Bethea Genesis HealthCareLori Greer-Harris Genesis HealthCareJerry Cahill Genesis HealthCareRayna Fagus Eduro HealthcareBrian Falkler FundamentalSara Farmer Genesis HealthCareTerry Harman Genesis HealthCareMichael Jacobs FundamentalJody Knox Lakeview Christian HomePete Looker South Valley Care CenterCynthia Myers Genesis HealthCareHeidi Trimble FundamentalLillian Werntz Genesis HealthCareHorace Winchester OnPointeIrene Torres Genesis HealthCareFran Chapman Fundamental

MCO Basic Principles that Should Drive a NM NF VBP Program (91418)

bull ldquoOne stop shoppingrdquo - a single programbull KPIs metrics must be standardized (national data)bull Leverage best practices in other statesbull Co-brandingbull Provider ownershipbuy-in contribute to design of programbull Provider centric (stratified by level of providers)bull All providers have the opportunity to ldquowinrdquo and there are early

winsbull Supports other goals (eg community reintegration)bull Based on Medicaid membersdatabull Financial component has to be significant enough to be an

incentivebull Rewards for both meeting targets and improvementbull Actuarially soundbull Sustainable over the long runbull Quarterly or semi-annual paymentsbull Some metric for resident satisfactionbull Consider special situations (eg behavioral health facilities)bull Figure out DSNIPbull Transparent feedback to providersbull Performance scorecardbull Payouts based on aggregate membershipbull Patient centered care (continuity)bull Include all stakeholders in this processbull Care is coordinated and integrated to address both PH and BH

and Social Determinates of Health (SDoH)bull Financial drivers are aligned with the populationrsquos needbull Have data management strategybull Quality measures should be understandable validreliable

achievable fair and worth the effort

Common Principles for both MCOs and Provider Advisory Group

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull All providers have the opportunity to ldquowinrdquo and there are early wins

bull Payouts based on Medicaid bed days (volume in each facility)

bull Quarterly or semi-annual paymentsbull Specialty facility special considerations

(eg behavioral health and wound care facilities)

bull Transparent feedback to providers

Provider Advisory Guiding Principles(101918)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Prospective and fair method for setting (and resetting) targets over time

bull Specialty facility special considerations (psych and wound care facilities)

bull More frequent payouts (eg every 3 months)bull Consideration in metric selection regarding time frames

(eg fall with injury may continue for 270 days)bull Possible for everyone to ldquowinrdquobull Opportunity to address behavioral and opioid patient

population (will discuss how later)bull Tiered system to provide extra reward for challenging

patients but need to be sure training and ability to provide care is in place

bull Defined conditions of participation (TBD)bull Need to address the DOH-related regulatory issues

related to taking on BH patientsbull Voluntarybull Transparent data ndash clearly publishedbull Need to evaluate retroactive changes in membershipbull Payouts based on Medicaid bed days (volume in each

facility)

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

List of topics for prioritization for Oct-DecMedication reconciliationProtocol development ndash first 24 hoursAdjunctive medication treatments for painSubstance use disorder (opioids)Coping and painRisk assessment toolsCommunication strategies Discharge data sets ndash what is out thereInfection control 101UTIs and protocol for ordering UAs

Medicaid QIHA ECHO Session October 26Standard Agendabull Welcome amp Updatesbull ldquoCaserdquo Discussion

ndash Facility presents challengendash Structured facilitated discussion

bull Clarifying questions ndash community facultybull Recommendations ndash community faculty

bull Brief Lecture (~10-15 minutes)bull ldquoCaserdquo Discussionbull Quality Toolbull Wrap Up

TIME ITEM LEADER GOAL1000ndash15 Welcome Tracy Smith BA Set stage for meeting

1015-55 Case Discussion 1 ndash San Juan

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1055-1125 Communication Strategies SBAR Tool

Marissa Hotze RN David Scrase MD

Discuss the importance of communication review late night scenarios and learn the SBAR tool

1125-55 Case Discussion 2 ndash Heights

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1150-55 Quality Tool Run Chart Rules

Tracy Smith BA Develop shared understanding of quality tools

1155-1200 Wrap up Tracy Smith BA Share in chat What went well What could we improve on How good of a job did our group do including everyone

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

Quality Measure Group 2013 2014 2015 2016 2017 Gap RankSS Pneumonia Vac NM 6831593 6443415 6739485 6834131 6969712 1341253 1SS Influenza Vac NM 7247877 6772346 6671301 6680579 7052135 1050172 2SS Pain NM 2326298 2305328 2409461 2399083 2269283 9028904 3LS Pneumonia Vac NM 8064335 7914562 7956349 8289466 8575912 8385886 4LS Pain NM 9452523 8633543 1144037 1135775 9733362 4161743 5LS ADL NM 1911791 1922245 1844584 1954841 1854308 3566242 6LS Influenza Vac NM 8627691 8887254 8717901 9145866 9261725 2315015 7LS Mobility Worse NM 198982 2141174 2050577 2292328 8SS Outpatient ED Visits NM 1389574 1337558 1335203 1494649 9LS PU NM 6347849 6174637 6079916 6209895 6727337 1124526 10LS Antipsychotic NM 191337 1723704 1645566 1715094 1670944 1026828 11LS Catheter NM 3301297 2943718 3512884 3313439 2530768 0665996 12SS Antipsychotic NM 2904668 2460702 2490567 2531788 2314779 0326286 13SS PU NM 0992341 0791212 1503379 1272956 1008694 0132106 14LS Weight Loss NM 7161366 6298023 7234606 7107744 7179254 0096303 15LS Falls w Injury NM 3680669 3858533 3988173 4239733 3461082 0087468 16LS Restraints NM 072376 0583683 0601877 0511199 0320772 -011002 17LS Depression NM 34918 3007546 2934389 3838857 468194 -018908 18LS UTI NM 5247255 4651044 3981836 3072016 289301 -076767 19SS Rehospitalization NM 201547 2026018 2021202 -088745 20SS Successful Dis to Comm NM 5180244 5973186 5967146 -263949 21SS Functional Impr NM 6128979 6350563 6387649 -359513 22

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

MCO VBP GroupName OrganizationQuinn Glenzinski Blue Cross Blue Shield of New MexicoDr Wei-Ann Bay Blue Cross Blue Shield of New MexicoSusan Dezavelle Blue Cross Blue Shield of New MexicoHolly Lawrence Blue Cross Blue Shield of New MexicoEric Cibak Blue Cross Blue Shield of New MexicoMichael Archuleta Blue Cross Blue Shield of New MexicoArlene Britt Blue Cross Blue Shield of New MexicoMary Eden Presbyterian Health PlanJordan Erp Presbyterian Health PlanHeather Ingram Presbyterian Health PlanDeb Revard Presbyterian Health PlanNathan Cogburn Western Sky Community CareDr Latha Shankar Western Sky Community CareMessina Martinez Western Sky Community CareRosanna Nelson Western Sky Community CareMarta Larson Western Sky Community CareDr David Scrase HSDEstevan Baca HSDErica Archuleta HSD

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

NAME OF FACILITY LOCATION OF FACILITY

Rio Rancho Center 4210 Sabana Grande SE Rio Rancho

Las Palomas Center 8100 Palomas NE ABQ 87109

The Rehabilitation of ABQ 5900 Forest Hills Dr NE ABQ 87109

Albuquerque Hts Healthcare 103 Hospital Loop NE ABQ 87109

Ladera Center 5901 Ouray Road NW ABQ 87120

Skies Healthcare 9150 McMahon NW ABQ 87114

Uptown Rehabilitation Center 7900 Constitution Ave NE ABQ 87110

Sandia Ridge Center 2216 Lester Dr NE ABQ 87112

Canyon Transitional Rehab 10101 Lagrima de Oro NE ABQ 87111

Genesis Bear Canyon 5123 Juan Tabo Blvd NE ABQ 87111

San Juan Center 806 West Maple Street Farmington 87401

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Provider Advisory GroupName OrganizationJason Espinoza New Mexico Health Care AssociationKelley Whitaker FundamentalPat Whitacre New Mexico Health Care AssociationLashuan Bethea Genesis HealthCareLori Greer-Harris Genesis HealthCareJerry Cahill Genesis HealthCareRayna Fagus Eduro HealthcareBrian Falkler FundamentalSara Farmer Genesis HealthCareTerry Harman Genesis HealthCareMichael Jacobs FundamentalJody Knox Lakeview Christian HomePete Looker South Valley Care CenterCynthia Myers Genesis HealthCareHeidi Trimble FundamentalLillian Werntz Genesis HealthCareHorace Winchester OnPointeIrene Torres Genesis HealthCareFran Chapman Fundamental

MCO Basic Principles that Should Drive a NM NF VBP Program (91418)

bull ldquoOne stop shoppingrdquo - a single programbull KPIs metrics must be standardized (national data)bull Leverage best practices in other statesbull Co-brandingbull Provider ownershipbuy-in contribute to design of programbull Provider centric (stratified by level of providers)bull All providers have the opportunity to ldquowinrdquo and there are early

winsbull Supports other goals (eg community reintegration)bull Based on Medicaid membersdatabull Financial component has to be significant enough to be an

incentivebull Rewards for both meeting targets and improvementbull Actuarially soundbull Sustainable over the long runbull Quarterly or semi-annual paymentsbull Some metric for resident satisfactionbull Consider special situations (eg behavioral health facilities)bull Figure out DSNIPbull Transparent feedback to providersbull Performance scorecardbull Payouts based on aggregate membershipbull Patient centered care (continuity)bull Include all stakeholders in this processbull Care is coordinated and integrated to address both PH and BH

and Social Determinates of Health (SDoH)bull Financial drivers are aligned with the populationrsquos needbull Have data management strategybull Quality measures should be understandable validreliable

achievable fair and worth the effort

Common Principles for both MCOs and Provider Advisory Group

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull All providers have the opportunity to ldquowinrdquo and there are early wins

bull Payouts based on Medicaid bed days (volume in each facility)

bull Quarterly or semi-annual paymentsbull Specialty facility special considerations

(eg behavioral health and wound care facilities)

bull Transparent feedback to providers

Provider Advisory Guiding Principles(101918)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Prospective and fair method for setting (and resetting) targets over time

bull Specialty facility special considerations (psych and wound care facilities)

bull More frequent payouts (eg every 3 months)bull Consideration in metric selection regarding time frames

(eg fall with injury may continue for 270 days)bull Possible for everyone to ldquowinrdquobull Opportunity to address behavioral and opioid patient

population (will discuss how later)bull Tiered system to provide extra reward for challenging

patients but need to be sure training and ability to provide care is in place

bull Defined conditions of participation (TBD)bull Need to address the DOH-related regulatory issues

related to taking on BH patientsbull Voluntarybull Transparent data ndash clearly publishedbull Need to evaluate retroactive changes in membershipbull Payouts based on Medicaid bed days (volume in each

facility)

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

List of topics for prioritization for Oct-DecMedication reconciliationProtocol development ndash first 24 hoursAdjunctive medication treatments for painSubstance use disorder (opioids)Coping and painRisk assessment toolsCommunication strategies Discharge data sets ndash what is out thereInfection control 101UTIs and protocol for ordering UAs

Medicaid QIHA ECHO Session October 26Standard Agendabull Welcome amp Updatesbull ldquoCaserdquo Discussion

ndash Facility presents challengendash Structured facilitated discussion

bull Clarifying questions ndash community facultybull Recommendations ndash community faculty

bull Brief Lecture (~10-15 minutes)bull ldquoCaserdquo Discussionbull Quality Toolbull Wrap Up

TIME ITEM LEADER GOAL1000ndash15 Welcome Tracy Smith BA Set stage for meeting

1015-55 Case Discussion 1 ndash San Juan

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1055-1125 Communication Strategies SBAR Tool

Marissa Hotze RN David Scrase MD

Discuss the importance of communication review late night scenarios and learn the SBAR tool

1125-55 Case Discussion 2 ndash Heights

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1150-55 Quality Tool Run Chart Rules

Tracy Smith BA Develop shared understanding of quality tools

1155-1200 Wrap up Tracy Smith BA Share in chat What went well What could we improve on How good of a job did our group do including everyone

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

QIHA

VBP

MCO VBP GroupName OrganizationQuinn Glenzinski Blue Cross Blue Shield of New MexicoDr Wei-Ann Bay Blue Cross Blue Shield of New MexicoSusan Dezavelle Blue Cross Blue Shield of New MexicoHolly Lawrence Blue Cross Blue Shield of New MexicoEric Cibak Blue Cross Blue Shield of New MexicoMichael Archuleta Blue Cross Blue Shield of New MexicoArlene Britt Blue Cross Blue Shield of New MexicoMary Eden Presbyterian Health PlanJordan Erp Presbyterian Health PlanHeather Ingram Presbyterian Health PlanDeb Revard Presbyterian Health PlanNathan Cogburn Western Sky Community CareDr Latha Shankar Western Sky Community CareMessina Martinez Western Sky Community CareRosanna Nelson Western Sky Community CareMarta Larson Western Sky Community CareDr David Scrase HSDEstevan Baca HSDErica Archuleta HSD

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

NAME OF FACILITY LOCATION OF FACILITY

Rio Rancho Center 4210 Sabana Grande SE Rio Rancho

Las Palomas Center 8100 Palomas NE ABQ 87109

The Rehabilitation of ABQ 5900 Forest Hills Dr NE ABQ 87109

Albuquerque Hts Healthcare 103 Hospital Loop NE ABQ 87109

Ladera Center 5901 Ouray Road NW ABQ 87120

Skies Healthcare 9150 McMahon NW ABQ 87114

Uptown Rehabilitation Center 7900 Constitution Ave NE ABQ 87110

Sandia Ridge Center 2216 Lester Dr NE ABQ 87112

Canyon Transitional Rehab 10101 Lagrima de Oro NE ABQ 87111

Genesis Bear Canyon 5123 Juan Tabo Blvd NE ABQ 87111

San Juan Center 806 West Maple Street Farmington 87401

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Provider Advisory GroupName OrganizationJason Espinoza New Mexico Health Care AssociationKelley Whitaker FundamentalPat Whitacre New Mexico Health Care AssociationLashuan Bethea Genesis HealthCareLori Greer-Harris Genesis HealthCareJerry Cahill Genesis HealthCareRayna Fagus Eduro HealthcareBrian Falkler FundamentalSara Farmer Genesis HealthCareTerry Harman Genesis HealthCareMichael Jacobs FundamentalJody Knox Lakeview Christian HomePete Looker South Valley Care CenterCynthia Myers Genesis HealthCareHeidi Trimble FundamentalLillian Werntz Genesis HealthCareHorace Winchester OnPointeIrene Torres Genesis HealthCareFran Chapman Fundamental

MCO Basic Principles that Should Drive a NM NF VBP Program (91418)

bull ldquoOne stop shoppingrdquo - a single programbull KPIs metrics must be standardized (national data)bull Leverage best practices in other statesbull Co-brandingbull Provider ownershipbuy-in contribute to design of programbull Provider centric (stratified by level of providers)bull All providers have the opportunity to ldquowinrdquo and there are early

winsbull Supports other goals (eg community reintegration)bull Based on Medicaid membersdatabull Financial component has to be significant enough to be an

incentivebull Rewards for both meeting targets and improvementbull Actuarially soundbull Sustainable over the long runbull Quarterly or semi-annual paymentsbull Some metric for resident satisfactionbull Consider special situations (eg behavioral health facilities)bull Figure out DSNIPbull Transparent feedback to providersbull Performance scorecardbull Payouts based on aggregate membershipbull Patient centered care (continuity)bull Include all stakeholders in this processbull Care is coordinated and integrated to address both PH and BH

and Social Determinates of Health (SDoH)bull Financial drivers are aligned with the populationrsquos needbull Have data management strategybull Quality measures should be understandable validreliable

achievable fair and worth the effort

Common Principles for both MCOs and Provider Advisory Group

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull All providers have the opportunity to ldquowinrdquo and there are early wins

bull Payouts based on Medicaid bed days (volume in each facility)

bull Quarterly or semi-annual paymentsbull Specialty facility special considerations

(eg behavioral health and wound care facilities)

bull Transparent feedback to providers

Provider Advisory Guiding Principles(101918)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Prospective and fair method for setting (and resetting) targets over time

bull Specialty facility special considerations (psych and wound care facilities)

bull More frequent payouts (eg every 3 months)bull Consideration in metric selection regarding time frames

(eg fall with injury may continue for 270 days)bull Possible for everyone to ldquowinrdquobull Opportunity to address behavioral and opioid patient

population (will discuss how later)bull Tiered system to provide extra reward for challenging

patients but need to be sure training and ability to provide care is in place

bull Defined conditions of participation (TBD)bull Need to address the DOH-related regulatory issues

related to taking on BH patientsbull Voluntarybull Transparent data ndash clearly publishedbull Need to evaluate retroactive changes in membershipbull Payouts based on Medicaid bed days (volume in each

facility)

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

List of topics for prioritization for Oct-DecMedication reconciliationProtocol development ndash first 24 hoursAdjunctive medication treatments for painSubstance use disorder (opioids)Coping and painRisk assessment toolsCommunication strategies Discharge data sets ndash what is out thereInfection control 101UTIs and protocol for ordering UAs

Medicaid QIHA ECHO Session October 26Standard Agendabull Welcome amp Updatesbull ldquoCaserdquo Discussion

ndash Facility presents challengendash Structured facilitated discussion

bull Clarifying questions ndash community facultybull Recommendations ndash community faculty

bull Brief Lecture (~10-15 minutes)bull ldquoCaserdquo Discussionbull Quality Toolbull Wrap Up

TIME ITEM LEADER GOAL1000ndash15 Welcome Tracy Smith BA Set stage for meeting

1015-55 Case Discussion 1 ndash San Juan

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1055-1125 Communication Strategies SBAR Tool

Marissa Hotze RN David Scrase MD

Discuss the importance of communication review late night scenarios and learn the SBAR tool

1125-55 Case Discussion 2 ndash Heights

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1150-55 Quality Tool Run Chart Rules

Tracy Smith BA Develop shared understanding of quality tools

1155-1200 Wrap up Tracy Smith BA Share in chat What went well What could we improve on How good of a job did our group do including everyone

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

NAME OF FACILITY LOCATION OF FACILITY

Rio Rancho Center 4210 Sabana Grande SE Rio Rancho

Las Palomas Center 8100 Palomas NE ABQ 87109

The Rehabilitation of ABQ 5900 Forest Hills Dr NE ABQ 87109

Albuquerque Hts Healthcare 103 Hospital Loop NE ABQ 87109

Ladera Center 5901 Ouray Road NW ABQ 87120

Skies Healthcare 9150 McMahon NW ABQ 87114

Uptown Rehabilitation Center 7900 Constitution Ave NE ABQ 87110

Sandia Ridge Center 2216 Lester Dr NE ABQ 87112

Canyon Transitional Rehab 10101 Lagrima de Oro NE ABQ 87111

Genesis Bear Canyon 5123 Juan Tabo Blvd NE ABQ 87111

San Juan Center 806 West Maple Street Farmington 87401

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Provider Advisory GroupName OrganizationJason Espinoza New Mexico Health Care AssociationKelley Whitaker FundamentalPat Whitacre New Mexico Health Care AssociationLashuan Bethea Genesis HealthCareLori Greer-Harris Genesis HealthCareJerry Cahill Genesis HealthCareRayna Fagus Eduro HealthcareBrian Falkler FundamentalSara Farmer Genesis HealthCareTerry Harman Genesis HealthCareMichael Jacobs FundamentalJody Knox Lakeview Christian HomePete Looker South Valley Care CenterCynthia Myers Genesis HealthCareHeidi Trimble FundamentalLillian Werntz Genesis HealthCareHorace Winchester OnPointeIrene Torres Genesis HealthCareFran Chapman Fundamental

MCO Basic Principles that Should Drive a NM NF VBP Program (91418)

bull ldquoOne stop shoppingrdquo - a single programbull KPIs metrics must be standardized (national data)bull Leverage best practices in other statesbull Co-brandingbull Provider ownershipbuy-in contribute to design of programbull Provider centric (stratified by level of providers)bull All providers have the opportunity to ldquowinrdquo and there are early

winsbull Supports other goals (eg community reintegration)bull Based on Medicaid membersdatabull Financial component has to be significant enough to be an

incentivebull Rewards for both meeting targets and improvementbull Actuarially soundbull Sustainable over the long runbull Quarterly or semi-annual paymentsbull Some metric for resident satisfactionbull Consider special situations (eg behavioral health facilities)bull Figure out DSNIPbull Transparent feedback to providersbull Performance scorecardbull Payouts based on aggregate membershipbull Patient centered care (continuity)bull Include all stakeholders in this processbull Care is coordinated and integrated to address both PH and BH

and Social Determinates of Health (SDoH)bull Financial drivers are aligned with the populationrsquos needbull Have data management strategybull Quality measures should be understandable validreliable

achievable fair and worth the effort

Common Principles for both MCOs and Provider Advisory Group

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull All providers have the opportunity to ldquowinrdquo and there are early wins

bull Payouts based on Medicaid bed days (volume in each facility)

bull Quarterly or semi-annual paymentsbull Specialty facility special considerations

(eg behavioral health and wound care facilities)

bull Transparent feedback to providers

Provider Advisory Guiding Principles(101918)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Prospective and fair method for setting (and resetting) targets over time

bull Specialty facility special considerations (psych and wound care facilities)

bull More frequent payouts (eg every 3 months)bull Consideration in metric selection regarding time frames

(eg fall with injury may continue for 270 days)bull Possible for everyone to ldquowinrdquobull Opportunity to address behavioral and opioid patient

population (will discuss how later)bull Tiered system to provide extra reward for challenging

patients but need to be sure training and ability to provide care is in place

bull Defined conditions of participation (TBD)bull Need to address the DOH-related regulatory issues

related to taking on BH patientsbull Voluntarybull Transparent data ndash clearly publishedbull Need to evaluate retroactive changes in membershipbull Payouts based on Medicaid bed days (volume in each

facility)

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

List of topics for prioritization for Oct-DecMedication reconciliationProtocol development ndash first 24 hoursAdjunctive medication treatments for painSubstance use disorder (opioids)Coping and painRisk assessment toolsCommunication strategies Discharge data sets ndash what is out thereInfection control 101UTIs and protocol for ordering UAs

Medicaid QIHA ECHO Session October 26Standard Agendabull Welcome amp Updatesbull ldquoCaserdquo Discussion

ndash Facility presents challengendash Structured facilitated discussion

bull Clarifying questions ndash community facultybull Recommendations ndash community faculty

bull Brief Lecture (~10-15 minutes)bull ldquoCaserdquo Discussionbull Quality Toolbull Wrap Up

TIME ITEM LEADER GOAL1000ndash15 Welcome Tracy Smith BA Set stage for meeting

1015-55 Case Discussion 1 ndash San Juan

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1055-1125 Communication Strategies SBAR Tool

Marissa Hotze RN David Scrase MD

Discuss the importance of communication review late night scenarios and learn the SBAR tool

1125-55 Case Discussion 2 ndash Heights

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1150-55 Quality Tool Run Chart Rules

Tracy Smith BA Develop shared understanding of quality tools

1155-1200 Wrap up Tracy Smith BA Share in chat What went well What could we improve on How good of a job did our group do including everyone

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

NAME OF FACILITY LOCATION OF FACILITY

Rio Rancho Center 4210 Sabana Grande SE Rio Rancho

Las Palomas Center 8100 Palomas NE ABQ 87109

The Rehabilitation of ABQ 5900 Forest Hills Dr NE ABQ 87109

Albuquerque Hts Healthcare 103 Hospital Loop NE ABQ 87109

Ladera Center 5901 Ouray Road NW ABQ 87120

Skies Healthcare 9150 McMahon NW ABQ 87114

Uptown Rehabilitation Center 7900 Constitution Ave NE ABQ 87110

Sandia Ridge Center 2216 Lester Dr NE ABQ 87112

Canyon Transitional Rehab 10101 Lagrima de Oro NE ABQ 87111

Genesis Bear Canyon 5123 Juan Tabo Blvd NE ABQ 87111

San Juan Center 806 West Maple Street Farmington 87401

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Provider Advisory GroupName OrganizationJason Espinoza New Mexico Health Care AssociationKelley Whitaker FundamentalPat Whitacre New Mexico Health Care AssociationLashuan Bethea Genesis HealthCareLori Greer-Harris Genesis HealthCareJerry Cahill Genesis HealthCareRayna Fagus Eduro HealthcareBrian Falkler FundamentalSara Farmer Genesis HealthCareTerry Harman Genesis HealthCareMichael Jacobs FundamentalJody Knox Lakeview Christian HomePete Looker South Valley Care CenterCynthia Myers Genesis HealthCareHeidi Trimble FundamentalLillian Werntz Genesis HealthCareHorace Winchester OnPointeIrene Torres Genesis HealthCareFran Chapman Fundamental

MCO Basic Principles that Should Drive a NM NF VBP Program (91418)

bull ldquoOne stop shoppingrdquo - a single programbull KPIs metrics must be standardized (national data)bull Leverage best practices in other statesbull Co-brandingbull Provider ownershipbuy-in contribute to design of programbull Provider centric (stratified by level of providers)bull All providers have the opportunity to ldquowinrdquo and there are early

winsbull Supports other goals (eg community reintegration)bull Based on Medicaid membersdatabull Financial component has to be significant enough to be an

incentivebull Rewards for both meeting targets and improvementbull Actuarially soundbull Sustainable over the long runbull Quarterly or semi-annual paymentsbull Some metric for resident satisfactionbull Consider special situations (eg behavioral health facilities)bull Figure out DSNIPbull Transparent feedback to providersbull Performance scorecardbull Payouts based on aggregate membershipbull Patient centered care (continuity)bull Include all stakeholders in this processbull Care is coordinated and integrated to address both PH and BH

and Social Determinates of Health (SDoH)bull Financial drivers are aligned with the populationrsquos needbull Have data management strategybull Quality measures should be understandable validreliable

achievable fair and worth the effort

Common Principles for both MCOs and Provider Advisory Group

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull All providers have the opportunity to ldquowinrdquo and there are early wins

bull Payouts based on Medicaid bed days (volume in each facility)

bull Quarterly or semi-annual paymentsbull Specialty facility special considerations

(eg behavioral health and wound care facilities)

bull Transparent feedback to providers

Provider Advisory Guiding Principles(101918)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Prospective and fair method for setting (and resetting) targets over time

bull Specialty facility special considerations (psych and wound care facilities)

bull More frequent payouts (eg every 3 months)bull Consideration in metric selection regarding time frames

(eg fall with injury may continue for 270 days)bull Possible for everyone to ldquowinrdquobull Opportunity to address behavioral and opioid patient

population (will discuss how later)bull Tiered system to provide extra reward for challenging

patients but need to be sure training and ability to provide care is in place

bull Defined conditions of participation (TBD)bull Need to address the DOH-related regulatory issues

related to taking on BH patientsbull Voluntarybull Transparent data ndash clearly publishedbull Need to evaluate retroactive changes in membershipbull Payouts based on Medicaid bed days (volume in each

facility)

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

List of topics for prioritization for Oct-DecMedication reconciliationProtocol development ndash first 24 hoursAdjunctive medication treatments for painSubstance use disorder (opioids)Coping and painRisk assessment toolsCommunication strategies Discharge data sets ndash what is out thereInfection control 101UTIs and protocol for ordering UAs

Medicaid QIHA ECHO Session October 26Standard Agendabull Welcome amp Updatesbull ldquoCaserdquo Discussion

ndash Facility presents challengendash Structured facilitated discussion

bull Clarifying questions ndash community facultybull Recommendations ndash community faculty

bull Brief Lecture (~10-15 minutes)bull ldquoCaserdquo Discussionbull Quality Toolbull Wrap Up

TIME ITEM LEADER GOAL1000ndash15 Welcome Tracy Smith BA Set stage for meeting

1015-55 Case Discussion 1 ndash San Juan

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1055-1125 Communication Strategies SBAR Tool

Marissa Hotze RN David Scrase MD

Discuss the importance of communication review late night scenarios and learn the SBAR tool

1125-55 Case Discussion 2 ndash Heights

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1150-55 Quality Tool Run Chart Rules

Tracy Smith BA Develop shared understanding of quality tools

1155-1200 Wrap up Tracy Smith BA Share in chat What went well What could we improve on How good of a job did our group do including everyone

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Provider Advisory GroupName OrganizationJason Espinoza New Mexico Health Care AssociationKelley Whitaker FundamentalPat Whitacre New Mexico Health Care AssociationLashuan Bethea Genesis HealthCareLori Greer-Harris Genesis HealthCareJerry Cahill Genesis HealthCareRayna Fagus Eduro HealthcareBrian Falkler FundamentalSara Farmer Genesis HealthCareTerry Harman Genesis HealthCareMichael Jacobs FundamentalJody Knox Lakeview Christian HomePete Looker South Valley Care CenterCynthia Myers Genesis HealthCareHeidi Trimble FundamentalLillian Werntz Genesis HealthCareHorace Winchester OnPointeIrene Torres Genesis HealthCareFran Chapman Fundamental

MCO Basic Principles that Should Drive a NM NF VBP Program (91418)

bull ldquoOne stop shoppingrdquo - a single programbull KPIs metrics must be standardized (national data)bull Leverage best practices in other statesbull Co-brandingbull Provider ownershipbuy-in contribute to design of programbull Provider centric (stratified by level of providers)bull All providers have the opportunity to ldquowinrdquo and there are early

winsbull Supports other goals (eg community reintegration)bull Based on Medicaid membersdatabull Financial component has to be significant enough to be an

incentivebull Rewards for both meeting targets and improvementbull Actuarially soundbull Sustainable over the long runbull Quarterly or semi-annual paymentsbull Some metric for resident satisfactionbull Consider special situations (eg behavioral health facilities)bull Figure out DSNIPbull Transparent feedback to providersbull Performance scorecardbull Payouts based on aggregate membershipbull Patient centered care (continuity)bull Include all stakeholders in this processbull Care is coordinated and integrated to address both PH and BH

and Social Determinates of Health (SDoH)bull Financial drivers are aligned with the populationrsquos needbull Have data management strategybull Quality measures should be understandable validreliable

achievable fair and worth the effort

Common Principles for both MCOs and Provider Advisory Group

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull All providers have the opportunity to ldquowinrdquo and there are early wins

bull Payouts based on Medicaid bed days (volume in each facility)

bull Quarterly or semi-annual paymentsbull Specialty facility special considerations

(eg behavioral health and wound care facilities)

bull Transparent feedback to providers

Provider Advisory Guiding Principles(101918)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Prospective and fair method for setting (and resetting) targets over time

bull Specialty facility special considerations (psych and wound care facilities)

bull More frequent payouts (eg every 3 months)bull Consideration in metric selection regarding time frames

(eg fall with injury may continue for 270 days)bull Possible for everyone to ldquowinrdquobull Opportunity to address behavioral and opioid patient

population (will discuss how later)bull Tiered system to provide extra reward for challenging

patients but need to be sure training and ability to provide care is in place

bull Defined conditions of participation (TBD)bull Need to address the DOH-related regulatory issues

related to taking on BH patientsbull Voluntarybull Transparent data ndash clearly publishedbull Need to evaluate retroactive changes in membershipbull Payouts based on Medicaid bed days (volume in each

facility)

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

List of topics for prioritization for Oct-DecMedication reconciliationProtocol development ndash first 24 hoursAdjunctive medication treatments for painSubstance use disorder (opioids)Coping and painRisk assessment toolsCommunication strategies Discharge data sets ndash what is out thereInfection control 101UTIs and protocol for ordering UAs

Medicaid QIHA ECHO Session October 26Standard Agendabull Welcome amp Updatesbull ldquoCaserdquo Discussion

ndash Facility presents challengendash Structured facilitated discussion

bull Clarifying questions ndash community facultybull Recommendations ndash community faculty

bull Brief Lecture (~10-15 minutes)bull ldquoCaserdquo Discussionbull Quality Toolbull Wrap Up

TIME ITEM LEADER GOAL1000ndash15 Welcome Tracy Smith BA Set stage for meeting

1015-55 Case Discussion 1 ndash San Juan

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1055-1125 Communication Strategies SBAR Tool

Marissa Hotze RN David Scrase MD

Discuss the importance of communication review late night scenarios and learn the SBAR tool

1125-55 Case Discussion 2 ndash Heights

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1150-55 Quality Tool Run Chart Rules

Tracy Smith BA Develop shared understanding of quality tools

1155-1200 Wrap up Tracy Smith BA Share in chat What went well What could we improve on How good of a job did our group do including everyone

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

QIHA

VBP

Provider Advisory GroupName OrganizationJason Espinoza New Mexico Health Care AssociationKelley Whitaker FundamentalPat Whitacre New Mexico Health Care AssociationLashuan Bethea Genesis HealthCareLori Greer-Harris Genesis HealthCareJerry Cahill Genesis HealthCareRayna Fagus Eduro HealthcareBrian Falkler FundamentalSara Farmer Genesis HealthCareTerry Harman Genesis HealthCareMichael Jacobs FundamentalJody Knox Lakeview Christian HomePete Looker South Valley Care CenterCynthia Myers Genesis HealthCareHeidi Trimble FundamentalLillian Werntz Genesis HealthCareHorace Winchester OnPointeIrene Torres Genesis HealthCareFran Chapman Fundamental

MCO Basic Principles that Should Drive a NM NF VBP Program (91418)

bull ldquoOne stop shoppingrdquo - a single programbull KPIs metrics must be standardized (national data)bull Leverage best practices in other statesbull Co-brandingbull Provider ownershipbuy-in contribute to design of programbull Provider centric (stratified by level of providers)bull All providers have the opportunity to ldquowinrdquo and there are early

winsbull Supports other goals (eg community reintegration)bull Based on Medicaid membersdatabull Financial component has to be significant enough to be an

incentivebull Rewards for both meeting targets and improvementbull Actuarially soundbull Sustainable over the long runbull Quarterly or semi-annual paymentsbull Some metric for resident satisfactionbull Consider special situations (eg behavioral health facilities)bull Figure out DSNIPbull Transparent feedback to providersbull Performance scorecardbull Payouts based on aggregate membershipbull Patient centered care (continuity)bull Include all stakeholders in this processbull Care is coordinated and integrated to address both PH and BH

and Social Determinates of Health (SDoH)bull Financial drivers are aligned with the populationrsquos needbull Have data management strategybull Quality measures should be understandable validreliable

achievable fair and worth the effort

Common Principles for both MCOs and Provider Advisory Group

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull All providers have the opportunity to ldquowinrdquo and there are early wins

bull Payouts based on Medicaid bed days (volume in each facility)

bull Quarterly or semi-annual paymentsbull Specialty facility special considerations

(eg behavioral health and wound care facilities)

bull Transparent feedback to providers

Provider Advisory Guiding Principles(101918)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Prospective and fair method for setting (and resetting) targets over time

bull Specialty facility special considerations (psych and wound care facilities)

bull More frequent payouts (eg every 3 months)bull Consideration in metric selection regarding time frames

(eg fall with injury may continue for 270 days)bull Possible for everyone to ldquowinrdquobull Opportunity to address behavioral and opioid patient

population (will discuss how later)bull Tiered system to provide extra reward for challenging

patients but need to be sure training and ability to provide care is in place

bull Defined conditions of participation (TBD)bull Need to address the DOH-related regulatory issues

related to taking on BH patientsbull Voluntarybull Transparent data ndash clearly publishedbull Need to evaluate retroactive changes in membershipbull Payouts based on Medicaid bed days (volume in each

facility)

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

List of topics for prioritization for Oct-DecMedication reconciliationProtocol development ndash first 24 hoursAdjunctive medication treatments for painSubstance use disorder (opioids)Coping and painRisk assessment toolsCommunication strategies Discharge data sets ndash what is out thereInfection control 101UTIs and protocol for ordering UAs

Medicaid QIHA ECHO Session October 26Standard Agendabull Welcome amp Updatesbull ldquoCaserdquo Discussion

ndash Facility presents challengendash Structured facilitated discussion

bull Clarifying questions ndash community facultybull Recommendations ndash community faculty

bull Brief Lecture (~10-15 minutes)bull ldquoCaserdquo Discussionbull Quality Toolbull Wrap Up

TIME ITEM LEADER GOAL1000ndash15 Welcome Tracy Smith BA Set stage for meeting

1015-55 Case Discussion 1 ndash San Juan

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1055-1125 Communication Strategies SBAR Tool

Marissa Hotze RN David Scrase MD

Discuss the importance of communication review late night scenarios and learn the SBAR tool

1125-55 Case Discussion 2 ndash Heights

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1150-55 Quality Tool Run Chart Rules

Tracy Smith BA Develop shared understanding of quality tools

1155-1200 Wrap up Tracy Smith BA Share in chat What went well What could we improve on How good of a job did our group do including everyone

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

MCO Basic Principles that Should Drive a NM NF VBP Program (91418)

bull ldquoOne stop shoppingrdquo - a single programbull KPIs metrics must be standardized (national data)bull Leverage best practices in other statesbull Co-brandingbull Provider ownershipbuy-in contribute to design of programbull Provider centric (stratified by level of providers)bull All providers have the opportunity to ldquowinrdquo and there are early

winsbull Supports other goals (eg community reintegration)bull Based on Medicaid membersdatabull Financial component has to be significant enough to be an

incentivebull Rewards for both meeting targets and improvementbull Actuarially soundbull Sustainable over the long runbull Quarterly or semi-annual paymentsbull Some metric for resident satisfactionbull Consider special situations (eg behavioral health facilities)bull Figure out DSNIPbull Transparent feedback to providersbull Performance scorecardbull Payouts based on aggregate membershipbull Patient centered care (continuity)bull Include all stakeholders in this processbull Care is coordinated and integrated to address both PH and BH

and Social Determinates of Health (SDoH)bull Financial drivers are aligned with the populationrsquos needbull Have data management strategybull Quality measures should be understandable validreliable

achievable fair and worth the effort

Common Principles for both MCOs and Provider Advisory Group

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull All providers have the opportunity to ldquowinrdquo and there are early wins

bull Payouts based on Medicaid bed days (volume in each facility)

bull Quarterly or semi-annual paymentsbull Specialty facility special considerations

(eg behavioral health and wound care facilities)

bull Transparent feedback to providers

Provider Advisory Guiding Principles(101918)

bull Rewards for both improvement (with defined tiers) and reaching targets

bull Evidence based benchmarks (tied to clinical outcomes and evidence)

bull Prospective and fair method for setting (and resetting) targets over time

bull Specialty facility special considerations (psych and wound care facilities)

bull More frequent payouts (eg every 3 months)bull Consideration in metric selection regarding time frames

(eg fall with injury may continue for 270 days)bull Possible for everyone to ldquowinrdquobull Opportunity to address behavioral and opioid patient

population (will discuss how later)bull Tiered system to provide extra reward for challenging

patients but need to be sure training and ability to provide care is in place

bull Defined conditions of participation (TBD)bull Need to address the DOH-related regulatory issues

related to taking on BH patientsbull Voluntarybull Transparent data ndash clearly publishedbull Need to evaluate retroactive changes in membershipbull Payouts based on Medicaid bed days (volume in each

facility)

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

List of topics for prioritization for Oct-DecMedication reconciliationProtocol development ndash first 24 hoursAdjunctive medication treatments for painSubstance use disorder (opioids)Coping and painRisk assessment toolsCommunication strategies Discharge data sets ndash what is out thereInfection control 101UTIs and protocol for ordering UAs

Medicaid QIHA ECHO Session October 26Standard Agendabull Welcome amp Updatesbull ldquoCaserdquo Discussion

ndash Facility presents challengendash Structured facilitated discussion

bull Clarifying questions ndash community facultybull Recommendations ndash community faculty

bull Brief Lecture (~10-15 minutes)bull ldquoCaserdquo Discussionbull Quality Toolbull Wrap Up

TIME ITEM LEADER GOAL1000ndash15 Welcome Tracy Smith BA Set stage for meeting

1015-55 Case Discussion 1 ndash San Juan

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1055-1125 Communication Strategies SBAR Tool

Marissa Hotze RN David Scrase MD

Discuss the importance of communication review late night scenarios and learn the SBAR tool

1125-55 Case Discussion 2 ndash Heights

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1150-55 Quality Tool Run Chart Rules

Tracy Smith BA Develop shared understanding of quality tools

1155-1200 Wrap up Tracy Smith BA Share in chat What went well What could we improve on How good of a job did our group do including everyone

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

List of topics for prioritization for Oct-DecMedication reconciliationProtocol development ndash first 24 hoursAdjunctive medication treatments for painSubstance use disorder (opioids)Coping and painRisk assessment toolsCommunication strategies Discharge data sets ndash what is out thereInfection control 101UTIs and protocol for ordering UAs

Medicaid QIHA ECHO Session October 26Standard Agendabull Welcome amp Updatesbull ldquoCaserdquo Discussion

ndash Facility presents challengendash Structured facilitated discussion

bull Clarifying questions ndash community facultybull Recommendations ndash community faculty

bull Brief Lecture (~10-15 minutes)bull ldquoCaserdquo Discussionbull Quality Toolbull Wrap Up

TIME ITEM LEADER GOAL1000ndash15 Welcome Tracy Smith BA Set stage for meeting

1015-55 Case Discussion 1 ndash San Juan

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1055-1125 Communication Strategies SBAR Tool

Marissa Hotze RN David Scrase MD

Discuss the importance of communication review late night scenarios and learn the SBAR tool

1125-55 Case Discussion 2 ndash Heights

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1150-55 Quality Tool Run Chart Rules

Tracy Smith BA Develop shared understanding of quality tools

1155-1200 Wrap up Tracy Smith BA Share in chat What went well What could we improve on How good of a job did our group do including everyone

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing quality metrics for pilot

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

List of topics for prioritization for Oct-DecMedication reconciliationProtocol development ndash first 24 hoursAdjunctive medication treatments for painSubstance use disorder (opioids)Coping and painRisk assessment toolsCommunication strategies Discharge data sets ndash what is out thereInfection control 101UTIs and protocol for ordering UAs

Medicaid QIHA ECHO Session October 26Standard Agendabull Welcome amp Updatesbull ldquoCaserdquo Discussion

ndash Facility presents challengendash Structured facilitated discussion

bull Clarifying questions ndash community facultybull Recommendations ndash community faculty

bull Brief Lecture (~10-15 minutes)bull ldquoCaserdquo Discussionbull Quality Toolbull Wrap Up

TIME ITEM LEADER GOAL1000ndash15 Welcome Tracy Smith BA Set stage for meeting

1015-55 Case Discussion 1 ndash San Juan

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1055-1125 Communication Strategies SBAR Tool

Marissa Hotze RN David Scrase MD

Discuss the importance of communication review late night scenarios and learn the SBAR tool

1125-55 Case Discussion 2 ndash Heights

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1150-55 Quality Tool Run Chart Rules

Tracy Smith BA Develop shared understanding of quality tools

1155-1200 Wrap up Tracy Smith BA Share in chat What went well What could we improve on How good of a job did our group do including everyone

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Medicaid QIHA ECHO Session October 26Standard Agendabull Welcome amp Updatesbull ldquoCaserdquo Discussion

ndash Facility presents challengendash Structured facilitated discussion

bull Clarifying questions ndash community facultybull Recommendations ndash community faculty

bull Brief Lecture (~10-15 minutes)bull ldquoCaserdquo Discussionbull Quality Toolbull Wrap Up

TIME ITEM LEADER GOAL1000ndash15 Welcome Tracy Smith BA Set stage for meeting

1015-55 Case Discussion 1 ndash San Juan

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1055-1125 Communication Strategies SBAR Tool

Marissa Hotze RN David Scrase MD

Discuss the importance of communication review late night scenarios and learn the SBAR tool

1125-55 Case Discussion 2 ndash Heights

Hub Team Discuss a facility challenge as a community and possible recommendations for solutions or next steps

1150-55 Quality Tool Run Chart Rules

Tracy Smith BA Develop shared understanding of quality tools

1155-1200 Wrap up Tracy Smith BA Share in chat What went well What could we improve on How good of a job did our group do including everyone

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q1 2018

bull Meet with Medicaid to establish program parameters

bull Meet with NMHCAbull Convene CAB

bull Research NF VBP programs in other states

Q2 2018

bull Build CAB and ECHO infrastructure

bull Select 10 ndash 12 Pilot NFs

bull Select four existing pilot quality metrics

bull Convene MCO VBP group and develop infrastructure

Q3 2018

bull Site visits to 11 pilot NFs

bull Begin Medicaid QIHA ECHO pilot with facility introductions

bull Convene NMHCA VBP group

bull Establish priorities for VBP

Q4 2018

bull Continue Medicaid QIHA ECHO pilot case presentations NF-prioritized curriculum

bull Plan ECHO expansion

bull Combine MCOs and NMHCA groups

bull Design VBP programbull Create Data Mgr RFP

QIHA

VBP

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Centennial Care and NF QIHAVBP Timeline

2018

Centennial Care 20 Effective(112019)

2019

Centennial Care 20 Contractors Named(12019)

Q2 2019

bull Outreach to additional NFs to enroll in QIHA

bull Revise agendas and curriculum to reflect VBP metrics

bull Finalize Data Mgrcontract

bull Create data use agreements

Q3 2019

bull Revised structure facilities and curriculum implemented

bull VBP program beginsbull Data reporting begins

Q4 2019

bull Planning for 2020 (TBD)

bull Payout for 1st Q (july ndashSeptember) of VBP

QIHA

VBP

Q1 2019

bull Pilot continues through March

bull Focus groups to evaluate pilot

bull Finalize plan for expansion

bull Complete data mgrRFP process

bull Select data vendorbull Finalize VBP metrics

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

The Structure Revised

Quality Improvement

Hospitalization Avoidance

Combined MCO and Provider VBP Team

Behavioral Health

Community Advisory Board

Project Leadership Group

Other Metrics

Data Manager

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Conclusions What we have learned so farhellip

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Conclusions What we have learned so farhellip1 Focus of QIHA and VBP will become long term care residents and metrics2 The concept of a statewide program resonates with the values of NF participants and the

business plans of MCOs3 This is much more popular than we expected in terms of QIHA participation by NFs4 This is much more popular than we expected in terms of VBP involvement of both MCOs and

NFs5 A successful VBP program requires co-development by all parties ndash efforts have stalled or

failed in other states without this6 This combined program is unique in that we are providing not only financial incentives to

improve quality but developing a unique statewide learning community to accelerate improvement this can become a model for other states and other countries

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments

Questions and Comments

• New Mexico Medicaid Value Based Purchasing and Nursing Facilities
• Agenda
• Follow-Up on Hepatitis C
• Population Changes in New Mexico (why is this topic so important)
• UNM BBER Population Data 1900httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1910httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1920httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1930httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1940httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1950httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1960httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1970httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1980httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 1990httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2000httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• UNM BBER Population Data 2010httpbberunmeduvisualizationsmigratedcensuscenhisthtm
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2020httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2030httpgpsunmedudataPopulation20Projectionshtml
• Robert Rhatigan UNM Geospatial and Population Studies Population Projections 2040httpgpsunmedudataPopulation20Projectionshtml
• NM Population 1900 and 2030
• World US and NM Population Data1900
• World US and NM Population Data 1970
• World US and NM Population Data 2010
• World US and NM Population Projections 2030
• In 2000 New Mexico ranked 39th among states in the percent of population ge 65 Where do you think we will rank in 2030
• Slide Number 26
• Important Differences in Health Services Use Rates in Older Population Demographics
• Brief Overview of Value Based Purchasing (VBP) in the United States
• History
• What does ldquoValuerdquo Mean
• Why Implement VBP Programs in Nursing Facilities
• Why Implement VBP Programs in Nursing Facilities
• Skilled Nursing Facility Value Based Purchasing Program 452014A Hospital Readmissions Reduction Program for SNFs
• CMS and Nursing Facility VBP
• Key NM Medicaid Nursing Facility Facts
• VBP in New Mexico Medicaid
• Slide Number 37
• How VBP ldquoWorksrdquo
• Centennial Care Timeline
• VBP Requirements in CC 20 RFP
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Nursing Facility-Specific VBP Programsin Other States (California Texas)
• Example 1 California2016-17 Point Allocation by Quality MeasurehttpswwwcdphcagovProgramsCHCQLCPCDPH20Document20LibraryCDPH2017QrtlyBenchmarksFNL508pdf
• 2013 Data California Quality and Accountability Supplemental Payments (QASP)Sourcehttpwwwdhcscagovservicesmedi-calDocumentsAB162920QASPQASP20Scoring_20Side20by20Side207112013pdf
• Example 2 Texas QIPP Program
• Project ECHO(Extension for Community Health Outcomes)Est 2003
• Slide Number 49
• The ECHO Modeltrade
• Slide Number 51
• Slide Number 52
• Nursing Facility Quality Improvement and Hospitalization Avoidance (QIHA) Program in New Mexico
• The Structure
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Slide Number 63
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• Medicaid QIHA ECHO Session October 26
• Slide Number 67
• Centennial Care and NF QIHAVBP Timeline
• Centennial Care and NF QIHAVBP Timeline
• The Structure Revised
• Conclusions What we have learned so farhellip
• Conclusions What we have learned so farhellip
• Questions and Comments