Monique Nugent, MD, MPH


Associate Director of Hospital Medicine, South Shore Hospital, South Weymouth, MA

Dr. Monique Nugent completed her training in Internal Medicine at Loma Linda University Medical Center in Loma Linda, CA.  Dr. Nugent possesses a strong desire to make logistical and administrative changes to improve access to, and care in, hospitals, post-acute care settings and has demonstrated her ability to do so.  She is also committed to working on behalf of uninsured and underinsured patients with the goal of improving health outcomes for all.  She is looking forward to a career in public health and policy where she can be part of the dynamic conversation that will create positive changes in healthcare.  Dr. Nugent completed an NIH post-baccalaureate research fellowship in the Mood and Anxiety program in 2004.  She received her medical degree from Loma Linda University in 2008 and completed the Mongan Commonwealth Fund Fellowship in 2014, receiving her Master in Public Health degree from the Harvard School of Public Health.

Value Based Purchasing (VBP) In Skilled Nursing Facilities: Improving Quality In A System With Multiple Players


The goal of this project was to create recommendations for Commonwealth Care Alliance (CCA) to consider when creating a value-based purchasing model for payment to skilled nursing facilities. 


Skilled nursing facilities provide moderate to low levels of care and physical rehabilitation; allowing patients to transition from hospital to home in a seamless manner.  Currently, the majority of payments made to skilled nursing facilities are fee for service payments.  As many payment models in healthcare are moving away from fee for service, the payment model for nursing homes must also be reassessed.  This project will present suggestions for guidelines when creating a value-based purchasing payment scheme for skilled nursing facilities.  This new payment model will work to incentivize process and outcome measures that will encourage skilled nursing facilities to deliver high quality care.  Process outcomes will also be incentivized with the goal of improving discharge processes, foregoing avoidable hospitalizations and avoiding protracted nursing home stays.


A structured review of value-based purchasing models as proposed by state and federal agencies was performed.  Directed interviews with multiple insurers, skilled nursing facilities as well as clinical providers were conducted to determine how these stakeholders view value-based purchasing. Small and large group meetings with various stakeholders were held to discuss the strengths and weaknesses of proposed models as well as stakeholder concerns.  Using the current Health and Human Services “Roadmap or Skilled Nursing Facilities Value Based Purchasing Implementation Plan” seven-point criteria, a matrix of official recommendations to Commonwealth Care Alliance was created.


A basic schema for VBP can be created, however specific contracts must be tailored to meet the individual needs and capabilities of the various skilled nursing facilities due to the side and network status of each skilled nursing facility.

Future Directions:     

While a “one size fits all” VBP model may not be accomplished to meet the needs of all the skilled nursing facilities under contact with CCA, continued partnering is needed to assure buy-in from skilled nursing facilities as specific process and outcome measures are identified to be included in the VBP scheme.


Dr. Randi Burkowitz, MD- Commonwealth Care Alliance