In 2007 the West Virginia Bureau for Medical Services was awarded several CMS grants through the Medicaid Transformation Program. Work from these projects led to the creation of the West Virginia Health Improvement Institute. Since its incorporation as a nonprofit organization in 2009, the Institute has led several pilot programs on primary care transformation to medical homes and use of health information technology to facilitate health care improvement. The Institute is currently working with the State to develop a Section 2703 Health Homes Program, leading the Tri-state Children's Health Improvement Consortium (T-CHIC) and acting as the West Virginia Regional Health Information Technology Extension Center (WVRHITEC).
Legislated in April 2013, the West Virginia Public Employees Insurance Act called for the evaluation and administration of programs to improve quality, improve health status of members, develop innovative payment methodologies, manage health care delivery costs, evaluate effective benefit designs, evaluate cost sharing and benefit based programs, and adopt effective industry programs that can manage the long-term effectiveness and costs for the programs at the Public Employees Insurance Agency to include implementation and evaluation of medical homes.
Dual Eligible | 2703 SPA | CPC | CPC+ | PCMH QHP | PCMH Legislation | Private Payer |
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Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
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Charleston Area Medical Center Medical Neighborhood Demonstration - West Virginia | Grant | Charleston | CMS Health Care Innovation Award - PCMN Demonstration | |
Public Employees Insurance Agency (PEIA) Medical Home Program | Other | Statewide | ||
Tri-state Children's Health Improvement Consortium - West Virginia | Grant | Alaska, Oregon, West Virginia | CHIPRA Quality Demonstration Grant | |
West Virginia Health Homes | Medicaid | Wayne, Cabell, Putnam, Kanawha, Raleigh, and Mercer counties | ACA Section 2703 Health Homes |
Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
---|---|---|---|---|
Highmark Blue Cross Blue Shield West Virginia | Commercial | Statewide | ||
Humana medical home program - Huntington Internal Medicine | Commercial | Huntington | Humana Medical Home Program |
Legislation | Status | Year |
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West Virginia Public Employees Insurance Act The Act called for the evaluation and administration of programs to improve quality, improve health status of members, develop innovative payment methodologies, manage health care delivery costs, evaluate effective benefit designs, evaluate cost sharing and benefit based programs, and adopt effective industry programs that can manage the long-term effectiveness and costs for the programs at the Public Employees Insurance Agency to include implementation and evaluation of medical homes. |
Enacted | 2013 |
SB 641 Primary Care Support Program This bill creates the Primary Care Support Program within the Bureau of Public Health within the Department of Health and Human Resources. The program will provide technical and organizational assistance to community-based primary care services. It will also create and administer a Primary Care Grant Fund to grant money to federally qualified health centers and federally qualified health center look-alikes, and secure federal medical assistance percentage funding. Federally qualified health center look-alikes already receiving grant funding at the time this program is created will continue to receive grant funding annually. Upon approval by the secretary of the department, federally qualified health centers in need of immediate financial assistance may be granted funding annually. All funds designated to federally qualified health centers may be transferred to Medicaid for the purpose of securing federal medical assistance percentage funding. Additionally, the secretary may use certain portions of funds within this account for activities in support of rural and primary care.
The Primary Care Support Program will conduct and make available upon request an annual primary care report which shall consist of total West Virginia Medicaid primary care expenditures as a percentage of total West Virginia Medicaid expenditures. |
Enacted | 2019 |
SB 641 Establishes a Primary Care Support Program within the Department of Health and Human Resources, that would, among other duties, conduct and make available upon request an annual primary care report which shall consist of total West Virginia Medicaid primary care expenditures as a percentage of total West Virginia Medicaid expenditures. |
Enacted | 2019 |