Virginia

The State of Virginia is undergoing significant reforms to their Medicaid program. As outlined by Secretary Hazel in April 2014, the 1st phase includes implementation of their dual eligibles program, the Commonwealth Coordinated Care Program. The second phase includes "Limited Provider Networks and Medical Homes." These will include creating an agreement with the federal government that allows for limited provider networks would afford Virginia’s MCO’s, health systems, and health care providers to create innovative models of  comprehensive care specific to a region, chronic condition, or co-occurring medical situations that span across physical and mental health. While number of providers may be reduced with a limited network, qualifying beneficiaries could receive higher quality coordinated care through a limited network arrangement.

CHIPRA: 
No
MAPCP: 
No
Dual Eligible: 
Yes
2703 Health Home: 
No
CPCi: 
No
SIM Awards: 
No
PCMH in QHP: 
No
Legislative PCMH Initiative: 
No
Private Payer Program: 
Yes
State Facts: 
Population:
8,180,700
Uninsured Population:
11%
Total Medicaid Spending FY 2013: 
$7.3 Billion 
Overweight/Obese Adults:
64.0%
Poor Mental Health among Adults: 
30.1%
Medicaid Expansion: 
No

McAuliffe gives up on Medicaid effort, pushes new plan for Virginia

Terry McAuliffe, Virginia's Democratic governor, has given up on his attempt to expand Medicaid on his own without the support of the GOP-led General Assembly. Instead, he is introducing program improvements for those currently enrolled through an executive order and a series of emergency regulations.

News Author: 
Virgil Dickson

Small practices key to CareFirst's medical home success

By combining forces, solo and small-group medical practices helped generate $237 million in savings over three years in CareFirst's Patient-Centered Medical Home Program, the insurer revealed Thursday.

News Author: 
Andis Robeznieks

CareFirst Patient-Centered Medical Home - Northern Virginia

CareFirst BlueCross BlueShield announced that the second-year of its PCMH program, one of the nation’s earliest and largest, demonstrated $98 million less in health care costs for its 1 million members. To support its PCMH program, the program facilitates implementation of care plans directed by primary care physicians with the support of local care coordination teams led by RN care coordinators. The care coordinators arrange for and track the care of those members who are at highest risk or who would benefit most from a comprehensive care plan.

New form of U.S. healthcare saves money, improves quality, one insurer finds

In one of the largest tests of a novel way to deliver and pay for healthcare, insurer CareFirst BlueCross BlueShield announced on Thursday that 1.1 million people receiving care through its "patient-centered medical homes" last year were hospitalized less often and stayed for fewer days compared to patients in traditional fee-for-service care.

News Author: 
Sharon Begley

Will Health Reform Bring New Role, Respect To Primary Care Physicians?

A few years ago it struck the D.C. region’s biggest medical insurer that the doctors who saw its members most often and knew them best got the smallest piece of the healthcare dollar. CareFirst BlueCross BlueShield spent billions on hospital procedures, drugs and specialty physicians to treat sick patients. Only one dollar in 20 went to the family-care doctors and other primary caregivers trained to keep people healthy.

The company’s move to shift that balance tells a lesser-known story of the Affordable Care Act and efforts to change the health system.

News Author: 
Jay Hancock

Humana medical home program - Carilion Clinic

This program is offered to practices that are either patient-centered medical home (PCMH) certified or in the certification process. These practices must meet HEDIS and clinical initiative targets and have made progress addressing some of the requirements necessary to transform their practice in order to become successful population health managers. For example PCMH program participants have implemented electronic medical records and likely use electronic prescribing systems. Additionally, they have made other infrastructure changes, including the use of a care coordinator in the practice.

Humana medical home program - Bon Secours

This program is offered to practices that are either patient-centered medical home (PCMH) certified or in the certification process. These practices must meet HEDIS and clinical initiative targets and have made progress addressing some of the requirements necessary to transform their practice in order to become successful population health managers. For example PCMH program participants have implemented electronic medical records and likely use electronic prescribing systems. Additionally, they have made other infrastructure changes, including the use of a care coordinator in the practice.

Commonwealth Coordinated Care - Virginia

CMS signed a Memorandum of Understanding with the state of Virginia on 5/21/2014. Commonwealth Coordinated Care is a new initiative to coordinate care for individuals who are currently served by both Medicare and Medicaid and meet certain eligibility requirements.

Origins In Oregon: The Alternative Payment Methodology Project

How the country pays for health care is currently at odds with its vision of how health care should be delivered. Traditional fee-for-service health care payments are linked to the volume of visits, rather than the quality of patient-centered care.

News Author: 
Craig Hostetler, Laura Sisulak, Erika Cottrell, Jill Arkind, and Sonja Likumahuwa

Cigna Collaborative Accountable Care Program - Loudoun Medical Group

Cigna and Loudoun Medical Group , one of the largest and most diverse physician-owned, multi-specialty group practices in Virginia, have launched a collaborative accountable care initiative to improve patient access to health care, enhance care coordination, and achieve the “triple aim”of improved health, affordability and patient experience. The program became effective October 1, 2013.

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