Virginia – Medical Homes

In 2010, the Virginia Department of Medical Assistance Services (DMAS) began developing plans for a medical home pilot with a federally qualified health center (FQHC) in southwest Virginia. The goal of the pilot was to improve primary care delivery within the framework of an existing primary care case management (PCCM) program. The expansion of Medicaid managed care to Southwest Virginia in July 2012 required a shift in plans for the pilot. Contracts between the state’s Medicaid MCOs and DMAS now require the MCOs to partner with DMAS in developing the southwest Virginia medical home pilot. Full contract language is available online here.

Last Updated: December 2013

Forming Partnerships
The Virginia Department of Medical Assistance Services (DMAS) has engaged a variety of stakeholders to develop the medical home pilot, including:
  • federally qualified health centers (FQHCs);
  • health systems;
  • provider practice groups;
  • private insurers that have established medical home programs; and
  • managed care organizations.
Defining & Recognizing a Medical Home
Definition: The Virginia Department of Medical Assistance Services’ (DMAS) contract with Medicaid managed care organizations (MCOs) identifies the following principles as “core” aspects of the medical home model:
  1. Demonstrated leadership;
  2. Team-based approach to care;
  3. Population risk stratification and management;
  4. Practice-integrated care management;
  5. Enhanced access to care;
  6. Behavioral-physical health integration;
  7. Connection to community resources;
  8. Commitment to reducing unnecessary health care spending, reducing waste, and improving cost-effective use of health care services;
  9. Integration of health information technology; and
  10. Inclusion of patients and families in implementation of the patient-centered medical home (PCMH) model.
Aligning Reimbursement & Purchasing The Virginia Department of Medical Assistance Services’ (DMAS) contracted Medicaid managed care organizations (MCOs) are establishing quality benchmarks that will help determine provider rewards. The MCOs have communicated that they will base initial goals on the measures selected by DMAS for its quality improvement program.