Year 2: What’s Going on Now
Earlier this year, the legislature allocated even more funding to continue the Health Security Plan design process. We’ve been working with our lead legislative sponsors—Sen. Jerry Ortiz y Pino and Rep. Dayan Hochman-Vigil—on what the priorities should be for this year.
In coordination with the Superintendent of Insurance, six topics have been selected. These topics address vital parts of the current system and solutions that are integral to the Health Security Plan. We’ll be excited to see what the consultants produce!
The first two selected topics build on last year’s research:
1. Global Budget Working Group—This topic builds on the global budgets research from last year. (View our summary here.) Global budgets provide guaranteed revenue for hospitals, which will particularly help our struggling rural hospitals and the communities that depend on them. This task force will bring together key stakeholders to establish priorities and research options for a hospital global budgeting program.
2. All-Payer Rate System—This topic builds on the recommendations from last year’s expert consultant on health care professional payment systems (to find out more, read the full report or view the slide deck). An all-payer payment system sets uniform reimbursement rates that apply to all health care professionals within a specialty and may apply to both private insurance companies and public programs like Medicaid. Such a system greatly reduces billing complexity and increases transparency.
The remaining four topics address other key aspects of our health care system:
3. Prescription Drug Affordability—This topic will focus on how to develop a prescription drug program that lowers prices for patients.
4. Medicaid—This topic will focus on understanding the cost of the Medicaid managed care program, which covers 900,000 New Mexico residents. To address issues around Medicaid (and its impact on the state budget), it is imperative to have an accurate picture of its true costs. As last year’s expert consultant on federal waivers mentioned in their report, Connecticut decided years ago to drop its Medicaid managed care program and have the state administer it instead because of rising costs.
5. Inter-Operational IT System—This topic will focus on how to create an inter-operational IT system that applies to all New Mexico payers (private insurance and public programs) and providers of health care services. This system would also include patient medical information (with privacy and security concerns addressed), so that no matter where you go to receive health care in New Mexico, providers have your medical history.
6. State Health Expenditure Data—This topic will focus on collecting full New Mexico health care expenditure data so we know what we are actually spending on health care in our state. This data will serve as a baseline for future years and should be collected annually going forward. All efforts to increase the effectiveness, stability, and sustainability of our health care system will benefit from having this data available.
Year 1: Research Results
With funding from the 2021 state legislature, the Office of Superintendent of Insurance contracted with several consultants last year to begin to explore possible solutions to two critical and challenging pieces of our health care system. Their research and recommendations focused on global budgets for hospitals and standardized payment systems for health care professionals.
The consultants also looked at federal laws that will affect the structure of our own health plan in New Mexico, along with federal waiver requirements to ensure that federal funding continues and recipients do not lose benefits.
The reports from these consultants contain a lot of excellent information, but we know it’s not easy to find the time to read over 100 pages of report text! Thus far, we’ve put together summaries of two of the three topics initially covered. Take a look!
The full reports can be found here.
A Multi-Year Process
Designing our own health plan that guarantees coverage for most New Mexicans will take time. It is important to get it right. We see this process as putting together solutions (such as global budgets) in phases. We can design the Plan piece by piece—as long as the ultimate goal and structure are always kept in mind—so we are not waiting to act until every part of the design is complete. There is no reason why we should delay in strengthening struggling hospitals, addressing escalating drug prices, and simplifying a system that discourages providers from wanting to practice medicine in our state.
As the design process continues this year, we will keep you posted about what is happening and how you can participate.
If a group of people in your community or an organization you belong to would like to find out more about this new and exciting phase, contact us at hsnmc.contact@gmail.com to set up a meeting or presentation.