April 15, 2025
Quality, Excellence, Staffing, and Teamwork (QuEST) are key to improving value for Maine’s nursing home residents.
A recently launched initiative, QuEST, aims to reward quality and value in Maine’s nursing facilities. QuEST uses value-based payments to incentivize higher quality, combined with technical assistance on quality improvement strategies. The effort was rolled out as part of Maine’s nursing home rate reform. Key areas targeted for improvement include staff stability, use of antipsychotic medications, and resident and family satisfaction. The Department is partnering with the Maine Health Care Association, which represents Maine’s nursing homes, and the Long-term Care Ombudsman Program to deliver the technical assistance.
QuEST had its origins with the Nursing Facility and Residential Care Innovation and Quality Advisory Council (IQAC), a group of interested partners first convened in April 2023 as the Department was beginning its redesign process for nursing home payments. The IQAC issued a report in January 2024, Improving Quality in Maine’s Nursing and Residential Care Facilities: Themes Emerging from the Nursing Home and Residential Care Facility Innovation and Quality Advisory Council, in which it identified priorities for achieving high quality, person-centered care in nursing homes, illustrated in the following diagram. First and foremost, a stable, well-trained direct care staff underpins quality in nursing homes, making excellent clinical outcomes and good resident experiences possible.
Based on the recommendations of the IQAC and other interest holders, three priority areas were identified for initial measures in the value-based payment (VBP) program:
- Total nursing staff turnover, which includes both nurses and Certified Nursing Assistants (CNAs), based on data already collected by the federal Centers for Medicare & Medicaid Services (CMS) and reported through the Five-Star Quality Rating System on CMS Care Compare;
- Rates of antipsychotic medication use, also available in Care Compare; and
- Resident and family satisfaction, as captured in the CoreQ satisfaction survey.
- In addition, the rate of urinary tract infections will be monitored but not included for purposes of calculating value-based payments.
QuEST partners are offering a 3-pronged technical assistance webinar series to participating facilities to help nursing homes focus on and improve their scores in these areas. The first prong, “Making Sense of VBP,” is led by MaineCare and focuses on understanding the components of the value-based payment program, including criteria, technical aspects, and supports available to improve outcomes in the targeted measures and to earn a share of the quality bonus pool. Participating facilities will receive individualized scorecards with their performance on each measure enabling them to see how they are doing in the first year before the scores begin impacting their payments in the second year. The second prong, the “Dementia Care Partnership” is led by the Maine Health Care Association and focuses on implementing non-pharmacological strategies to decrease the inappropriate use of antipsychotic medications among nursing home residents. Finally, the “Culture Change Coalition,” led by the Office of Aging and Disability Services, is built upon tools and strategies contained in the Artifacts of Culture Change 2.0. This initiative offers changes in workplace culture as a strategy for empowering staff, decreasing turnover, and reducing the use of temporary agency staff. In 2025, participation in these three initiatives under the QuEST umbrella, along with other quality activities, will determine each nursing home’s eligibility for a portion of an $8.1 million quality bonus pool. Beginning in 2026, quality payments will progressively be more challenging and awarded based on measured outcome performance. These efforts represent the first time that Maine nursing homes have a direct financial incentive to improve quality for their residents.