The Office of Quality and Population Health strongly believes in the principle of data transparency and the use of data to drive informed decisions. Several quality data and analytic products are produced to help focus and drive quality improvement within the Department of Medical Assistance Services (DMAS):
Annual Technical Reports (ATR)
The ATR evaluates the managed care organizations’ (MCOs) strengths and weaknesses related to quality outcomes, timeliness, access to care, items, and services in its contract. The ATR also recommends improvements to the quality of health care services, provides comparisons between MCOs, and provides an assessment of how well MCOs addressed prior-year recommendations for improvement. The report serves as an annual review of the MCOs' progress toward achieving the goals of the Quality Strategy.
Quality Strategy Report
DMAS develops a Quality Strategy to constantly monitor, test, and improve the timeliness and delivery of quality health care to all Virginia Medicaid and Children’s Health Insurance Program (CHIP) members served by the managed care and Fee-for-Service (FFS) programs. DMAS’s Quality Strategy provides the structure to complete DMAS’s goal of designing and implementing a coordinated, complete and thorough system to proactively drive quality throughout the Virginia Medicaid and CHIP system.
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.
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.
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 CCC Plus and Medallion 4.0 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.
Family Access to Medical Insurance Security (FAMIS) Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey
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, per the Centers for Medicare & Medicaid Services’ (CMS’s) Children’s Health Insurance Program Reauthorization Act (CHIPRA) CAHPS reporting requirements.
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.