Our latest Innovations of the Month features New Mexico Health Connections. This post initially appeared in NASHCO’s newsletter, News from NASHCO. To view the full newsletter or to sign up to receive it, please click here.
New Mexico Health Connections (NMHC) was one of the first CO-OPs to be awarded a loan from the Department of Health and Human Services in February 2012. Since that time, New Mexico Health Connections has continued to lead the way in innovation, both in the Land of Enchantment and nationally. In fact New Mexico Health Connections’ CEO Dr. Martin Hickey also serves as Chair of NASHCO’s Board of Directors.
Since its founding, NMHC has developed a Shared Savings Program (SSP) with about a dozen Primary Care and Multispecialty Groups around the State, predominantly Federally Qualified Health Centers. The program consists of:
• “Investment” – panel management fee and pay for participation in educational events.
• “Incentive” – a fee-for-service set of pay for activities around care coordination and patient centered medical home.
• “Rewards” – a formal shared savings element based on achieving a total medical spend below the Medical Loss Ratio requirement.
A particularly innovative program is a fee-for-service model of payment to incentivize non-licensed, clinic- and community-based community health workers to connect with recently hospitalized members.
NMHC is also developing a behavioral health/primary care physician integration project for members with diabetes to connect them to behavioral health care, through group visits as well as through sharing member-specific clinical info between the patient’s primary care physician and behavioral health provider. NMHC is implementing a behavioral health screening tool targeted toward members with one or more of nine different chronic physical health conditions that put the member at risk for poorer outcomes. In addition, a patient’s first three outpatient behavioral health visits have $0 copays, and the vast majority of generic medicines associated with the treatment of these nine chronic conditions have $0 copays.
Finally, NMHC is also working with its most frequently used hospital’s case management team to explore a mobile, secure, and HIPPA-compliant messaging system to find greater efficiencies in case management communications and activities, thus reducing delays in hospital throughput, reducing cost, and supporting a more coordinated post-hospital discharge member experience.
We look forward to New Mexico Health Connections continuing to put these plans into practice in 2015.