Population Health Unit

Overview

Population Health is defined as the health of a population as measured by health status indicators, and is influenced by a variety of social, economic, and physical factors. The Population Health (PH) Unit helps with coordinating projects for DMAS, focusing on population health trends and possible health care gaps, including maternal health, behavioral health, foster care, health equity, and social determinants of health. The PH Unit is responsible for identifying, collecting, carefully studying, and maintaining quality and population health data from managed care organizations (MCOs) and working with the Quality Improvement unit to provide feedback and recommendations on areas of opportunity for improvement.

Population Health Management (PHM) is the process of improving medicine-based health results of the whole population, by providing improved care coordination and member engagement by using effective care and managing money models. The MCOs review Population Health Management (PHM) for their members, and monitor and share the results with DMAS. According to the National Committee of Quality Assurance (NCQA), at a minimum PHM deals with the needs of the member by focusing on the following key areas:

Keeping members safe
Managing members with newly appearing high risks
Monitoring patient safety or results across settings
Managing multiple long-lasting illnesses

Overall, the Population Health (PH) Unit, using this data-driven approach to population health, works to advance DMAS’s mission to continue to improve the health of Virginians and make sure members receive access to high-quality care.

Healthcare Effectiveness Data and Information Set (HEDIS®)

Healthcare Effectiveness Data and Information Set (HEDIS®) is a national standard that is widely used to present performance measures in the managed care industry, and is collected and maintained by the National Committee of Quality Assurance (NCQA). HEDIS® is designed to provide information to compare the performance of health plans, and has several measures across 6 domains, including:

Effectiveness of Care
Access/Availability of Care
Experience of Care
Utilization and Risk-Adjusted Utilization
Health Plan Descriptive Information
Measures Reported Using Electronic Clinical Data Systems

The Population Health Unit designed dashboards that include select Virginia measures, and can be accessed using the link below.

Reference: Managed Care HEDIS® Dashboards

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is a member satisfaction survey that has been used as the industry standard by the National Committee for Quality Assurance (NCQA) and the Center for Medicare and Medicaid Services (CMS) to measure member satisfaction with their care. DMAS requires its managed care organizations (MCOs) to provide this survey to all of their enrolled members. This survey covers domains including:

Patient ease of obtaining information from a health plan;
Timeliness of service; and
Speed and accuracy of claims processing

Family Access to Medical Insurance Security (FAMIS) CAHPS

The FAMIS CAHPS Survey is a consumer satisfaction survey administered annually to FAMIS members receiving health care services through Fee-for-Service (FFS) or managed care. The FAMIS CAHPS Survey is administered to a statewide sample of FAMIS members, representative of the entire population of children covered by Virginia's Title XXI program (i.e., Children's Health Insurance Program (CHIP) members in FFS or managed care), per the Centers for Medicare and Medicaid Services' (CMS's) Children's Health Insurance Program Reauthorization Act (CHIPRA) CAHPS reporting requirements.

Reference: Quality and Population Health Studies and Reporting page

Consumer Decision Support Tools

Consumer Decision Support Tools are designed to help people make informed choices about their health by allowing consumers the opportunity to compare health plans on benefits, costs and provider networks. These tools show how well the different Commonwealth Coordinated Care Plus (MLTSS) and Medallion 4.0 (Acute) managed care organizations (MCOs) provide care and services in various performance areas. The ratings for each area summarize how the CCC Plus (MLTSS) and Medallion 4.0 (Acute) MCOs perform on a number of related standards.

Reference: Quality and Population Health Data and Dashboards page

Medicaid and CHIP Maternal and Child Health Focus Study (Formerly known as the Prenatal Care and Birth Outcomes Focus Study)

DMAS has worked with Health Services Advisory Group, Inc. (HSAG) since the state fiscal year 2015-2016 to complete an annual focus study that includes measurable information about prenatal care and linked birth outcomes among women with births paid by Title XIX or Title XXI. Title XIX or Title XXI includes Medicaid, Family Access to Medical Insurance Security (FAMIS), FAMIS MOMS, FAMIS Prenatal Coverage, Medicaid Expansion, and Low-Income Families with Children (LIFC) programs.

Reference: Quality and Population Health Studies and Reporting page

Child Welfare Focus Study (Formerly known as the Foster Care Focused Study)

DMAS has worked with Health Services Advisory Group, Inc. (HSAG) since the state fiscal year 2015-2016 to complete an annual focus study that evaluates health care use among members in child welfare programs receiving medical services through Medicaid managed care organizations (MCOs). The groups included in the study are Children in Foster Care, Adoption Assistance Children, and Former Foster Children.

Reference: Quality and Population Health Studies and Reporting page

Encounter Data Validation

Accurate and complete encounter data are critical to the success of a managed care program. Therefore, DMAS reviews the encounter data submitted by its Cardinal Care Managed Care contracted MCOs. DMAS relies on the quality of these encounter data submissions to accurately and effectively monitor and improve the programs’ quality of care, generate accurate and reliable reports, develop appropriate capitated rates, and obtain complete and accurate utilization information.

Reference: Quality and Population Health Studies and Reporting page

Dental Utilization in Pregnant Women Study

DMAS works with its External Quality Review Organization (EQRO) to complete a study of dental service utilization among pregnant women. The study evaluates dental use and birth outcomes among pregnant women in Virginia’s Medicaid and FAMIS MOMS programs.

Reference: Quality and Population Health Studies and Reporting page