State Government and Payer Solutions

Net Health provides specialized consulting, analytics services, software solutions, and comprehensive support across the healthcare continuum. As a trusted state government and payer partner, we help clients accelerate value-based care innovations to transform payment and healthcare delivery. 

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Data Aggregator

Analytics Provider

Software Supplier

Accelerate Your Value-Based Care Program

As a data intermediary and trusted partner, we work with state Medicaid agencies and health plans to design, implement, operate, and evaluate value-based care programs that align with their quality strategies. We work with states to develop programs for their delivery systems that focus on areas of priority, target provider settings and beneficiary populations of interest, and include a comprehensive array of measures leveraging diverse data sources.

Areas of Priority

  • Clinical Outcomes
  • Utilization
  • Access to Healthcare Services
  • Health Equity and Social Determinants of Health (SDOH)

Delivery Systems

  • Fee-for-Service
  • Managed Care

Provider Types/Settings

  • Hospital
  • Nursing Facility
  • Primary Care
  • Other

Domains and Populations

  • Physical Health
  • Behavioral Health
  • -LTSS (Long-Term Services and Supports)
  • Substance Use Disorder
  • Maternal Health
  • Complex Care
  • Chronic Care
  • Palliative/End-of-Life

Measures

  • Clinical
  • Utilization
  • Satisfaction
  • Process
  • Outcome
  • Structural


Data Source Options

  • Claims/MMIS (Medicaid Management Information System)
  • EHR (Electronic Health Record)
  • MDS (Minimum Data Set)
  • Publicly-reported
  • Submitted by Providers



How Net Health Helps States and Payers

We empower our clients with actionable insights to support informed decision-making and achieve improvements in care quality and outcomes. Net Health’s subject matter experts can provide comprehensive advice on value-based care program development, the State Plan Amendment, and required rule-making/statutory changes.

Analytics Services

  • Data diligence, validation, and analyses
  • Measure development and selection
  • Baselines and benchmarking
  • Performance assessment and payment methodologies
  • Models and “what if” scenarios to support decision making

Reporting and Software Solutions

  • Data management and aggregation
  • Robust reporting and data exports
  • Software-as-a-service solutions for payers and providers:
    • Value-based purchasing (VBP) pay for performance (P4P) scorecards
    • Provider quality improvement solutions
    • Patient care management solutions

Comprehensive and Ongoing Support

  • Deep subject matter expertise in provider, payer, and state government for trusted advisership
  • Consultative and collaborative approach
  • World class user support
  • Federal and state regulatory/legislative support
  • Stakeholder facilitation

Proven Operational and Clinical Results for States and Payers

For our clients in New Mexico, key stakeholders are actively engaged and aligned, providers attribute improvements in quality and operational outcomes to the programs, and there has been meaningful and sustained improvement in clinical and utilization measures.

Net Health’s two New Mexico programs were among only four of the 30 existing nursing home Medicaid VBP programs across 24 states that were fully or highly aligned with best practices in the Center for Health Policy Evaluation in Long-Term Care (CPHE) study, A Review of Nursing Home Medicaid Value-Based Payment Programs (February 2022).

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Measurable Quality Improvement In New Mexico Nursing Facilities

  • Improvement in long-stay hospitalization and pressure ulcers
  • Some individual facilities have significantly improved in multiple quality areas

Provider Support and High Levels of Satisfaction

  • Supported repeal of the provider surcharge sunset and continuation of both VBP programs
  • Provider testimonials
  • NPS score with best-in-class performance

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