This brief highlights the major strategies, lessons learned, and outcomes from West Virginia’s experience during the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) from February 2010 to August 2015.
West Virginia’s Goals: Improve the quality of care for children by 1) helping practices to implement the patient-centered medical home model 2) encouraging improvement in child- focused quality measures 3) increasing the use of the State’s Health Information Exchange.
Overview of model
West Virginia helped 10 practices in rural and suburban areas implement components of the patient centered medical home (PCMH); practices hired care coordinators and used EHRs to identify patients who needed preventive services (immunizations, well-child visits and follow-care)
Care coordinators in 6 of the 10 practices called caregivers before a patient’s visit to identify urgent or critical issues the caregiver wanted to discuss so that the provider was better prepared for the visit
4 out of 10 participating practices became recognized as PCMHs
State-hired facilitators helped practices improve reporting on the Child Core Set quality measures, states sent quality reports to practices that compared their performance against other practices, facilitators then used reports to target QI efforts
Partnerships: West Virginia partnered with Oregon and Alaska and shared best practices
Challenges: 1) Some practices found it challenging to implement care coordination and worried about reimbursement; 2) Practices were concerned about sustaining PCHM components because there is no payment tied to this work; 3) Some practices struggled to become recognized PCMHs because of cost and required paperwork; and 4) Delayed implementation of the Health Information Exchange (HIE) limited WV’s ability to enhance electronic communication among providers and between providers and caregivers