Virginia Improves Medicaid Care Management With AHRQ Tools

Prevention and Care Management
March 2009

Virginia has changed its Medicaid disease management program measures and design as a result of being part of an AHRQ-supported Learning Network. The Medicaid Care Management Learning Network serves State Medicaid agencies that operate care management programs for chronically ill beneficiaries in fee-for-service plans or primary care case management programs. Virginia is one of 17 States participating in the Learning Network.

The Learning Network provides expertise to participating States in four key areas critical to ensuring a quality-driven care management program, as follows:

  • Helping patients become active in their care.
  • Encouraging provider participation in care management programs.
  • Creating program interventions aligned with the State's measurement strategy that will impact patient care.
  • Designing valid and reliable evaluations to determine program success.

Virginia began operating a disease management program for its beneficiaries in primary care case management in January 2006. Through a contract with Health Management Corporation, Virginia provides disease management services for patients with asthma, diabetes, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease. The program serves patients through a call center, nurse care management, and disease education.

Adrienne Fegans, Program Operations Administrator, Virginia Department of Medical Services, notes, "The Learning Network faculty was extremely helpful during our contract negotiations with Health Management Corporation by assisting in the development of HEDIS-like measures."

AHRQ provided technical assistance on measurement through several calls with Virginia State officials, workshops, and a site visit. With this assistance, Virginia developed a more robust measurement strategy to understand program successes.

Through the AHRQ-supported Learning Network workshops, Virginia received an overview of the importance of measurement. Sessions focused on aligning measures with interventions and reviewing evaluation methods (e.g., random control trials versus pre/post tests). Using the measurement expertise of AHRQ staff and the AHRQ Medicaid Care Management Guide, the agency provided recommendations on the following:

  • Setting clinically meaningful measurement goals.
  • Measuring patient satisfaction.
  • Setting relative vs. absolute measurement goals.
  • Measuring medication adherence and use.
  • Screening members for depression.
  • Measuring return on investment.

AHRQ's Learning Network also made an impact on Virginia's program design. Influenced by the experience of other States participating in the Learning Network and technical assistance from AHRQ, Virginia officials made changes to its program and avoided initiatives that may not have produced clinical or financial returns.

Suzanne Gore, Integrated Care Program Manager, Virginia Department of Medical Assistance Services, notes, "Knowing which activities may not produce expected returns is as important as [identifying] new initiatives."

For example, Virginia officials had considered implementing a pay-for-performance (P4P) initiative. After learning about other States' experiences with P4P and examining the available evidence, Virginia decided not to pursue such an initiative at this time.

Similarly, as a result of the Learning Network group technical assistance and the lessons learned highlighted in AHRQ's Designing and Implementing Medicaid Care Management Programs: A User's Guide, Virginia officials gained information about the strengths and weaknesses of risk contracts. Specifically, they learned about the difficulties other States experienced in reconciling their vendor contracts, and subsequently decided not to pursue a risk-based contract.

For more information on the Learning Network, go to:

Impact Case Study Identifier: 
AHRQ Product(s): Medicaid Medical Directors Learning Network
Topics(s): Chronic Care: Self-Management, Policy
Geographic Location: Virginia
Implementer: Commonwealth of Virginia
Date: 03/01/2009
Page last reviewed October 2014