West Virginia – Medical Homes

The West Virginia Bureau of Medical Services (Medicaid) has actively partnered with the multi-stakeholder West Virginia Health Improvement Institute (WVHII) to promote medical home development. Recently, West Virginia completed a two-year Medical Home Performance Incentive Pilot developed by the WVHII’s Measurement Work Group. Three payers, including a Medicaid managed care plan and the state employee health plan, funded technical assistance to support NCQA Patient-Centered Medical Home recognition and participating practices were eligible to receive shared savings.

In January 2012, West Virginia was selected to join the North Carolina Infrastructure for Maintaining Primary Care Transformation (IMPaCT) Learning Community. As a part of this Learning Community, West Virginia was one of four states to receive technical assistance and guidance from North Carolina on how to develop a primary care support and quality improvement system. Through the IMPaCT initiative West Virginia created a shared vision for health care delivery in the state, described by stakeholders in a 2012 white paper. The white paper references medical homes as one possible strategy to support better health outcomes in the state.

Federal Support: West Virginia has received a planning grant from the Centers for Medicare & Medicaid Services (CMS) to develop a state plan amendment to implement Section 2703 of the Affordable Care Act (ACA), establishing health homes for Medicaid enrollees with chronic conditions. The state is working closely with the West Virginia Health Improvement Institute. Visit the Institute’s Health Homes webpage for more information about the planning process. To learn more about Section 2703 Health Homes, visit the CMS Health Homes webpage.

West Virginia is also participating in the Tri-State Child Health Improvement Consortium (T-CHIC), a CHIPRA Quality Demonstration Project funded by the Centers for Medicare & Medicaid Services (CMS), with Oregon and Alaska.

Last updated: April 2014

Forming Partnerships
The West Virginia Health Improvement Institute (WVHII), a partner of West Virginia Medicaid, provided a multi-stakeholder forum for development of the Medical Home Performance Incentive Pilot.
The West Virginia Bureau of Medical Services is also leading a stakeholder advisory group for Affordable Care Act Section 2703 Health Homes that is open to all interested stakeholders. This advisory group includes four workgroups:
  • Health Home Workgroup
  • Community Care Coordination Workgroup
  • Member Engagement Workgroup
  • Measures and Outcomes Workgroup
West Virginia participated in the North Carolina Infrastructure for Maintaining Primary Care Transformation (IMPaCT) Learning Community, where it was one of four states to receive technical assistance and guidance from North Carolina on how to develop a primary care support and quality improvement system. Through this project West Virginia built on partnerships developed through the WVHII to strengthen public-private collaboration. West Virginia strengthened important partnerships between health care practitioners, local health departments, MCO officials, and medical school leaders.
Defining & Recognizing a Medical Home
Recognition: Practices that participated in the Medical Home Performance Incentive Pilot were expected to apply for NCQA PCMH Recognition within nine months of the project start date.
Aligning Reimbursement & Purchasing
Providers and payers that participated in the Medical Home Performance Incentive Pilot agreed to share 5 percent of net savings (2.5 percent to providers, 2.5 percent to payers.) Providers also received compensation for lost revenue during learning sessions and NCQA PCMH application costs.
Payer and provider participation in the Medical Home Performance Incentive Pilot was voluntary. The following payers participated:
  • UniCare (Medicaid managed care)
  • Highmark Blue Cross Blue Shield
  • Public Employees Insurance Agency (state employees)
Supporting Practices
Practices that participated in the Medical Home Performance Incentive Pilot received a technical assistance package valued at $25,000 per practice, including:
  • A practice assessment;
  • Access to learning events (including face-to-face sessions, webinars, and monthly conference calls);
  • Training and practice coaching to meet NCQA standards; and
  • Preparation for measures reporting.
Measuring Results
The Medical Home Performance Incentive Pilot focused on the following outcomes:
  • Clinical process measures
  • Clinical outcome measures
  • Utilization
  • Cost
  • Alignment with Meaningful Use
In the West Virginia Health Improvement Institute’s (WVHII) 2012 annual report, WVHII reported that providers felt the pilot improved their workflows and care planning capabilities. While the costs for patients attributed to the demonstration rose 0.6% over the life of the pilot, costs for practices that did not achieve NCQA recognition rose by 2.0%.