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Joint Commission on Health Care Seeks Public Comment on Studies of Team-Based Care and Vertically Integrated Carriers and Providers

The Joint Commission on Health Care received briefings from its staff on two studies on September 20 and is seeking comments from the public.  Comments must be submitted by close of business on Friday, October 6, and may be sent via email to or via U.S. Mail to 411 E. Franklin Street, Suite 505, Richmond, VA 23219.

Team-based care This study directed staff to review evidence-based models of team-based care (the provision of health services by at least two professionals who work collaboratively with patients and caregivers to accomplish shared goals) and their effectiveness at improving outcomes; determine the extent to which team-based care is being used in Virginia and any obstacles to its implementation; and consider policy options for the state to promote effective models of team-based care.  The study focused on the provision of primary care through teams and found that team-based care addresses social determinants of health and improves care for individuals with chronic conditions, such as depression, diabetes, or hypertension; care teams offer services such as preventive care, medication management, and behavioral health care.  The study documented challenges limiting the use of team-based care, including workforce shortages in key practice areas, such as nurse practitioners, physician assistants, and care coordinators; the need for additional administrative support for practices transitioning to team-based care; fee-for-service payment models that discourage team-based care; and limited reimbursements for integrated behavioral health and pharmacy services.

Among the policy options proposed for consideration are the following:

  • Direct the Department of Medical Assistance Services (DMAS) to establish a reimbursement rate for Collaborative Care Model Services, which embed behavioral health providers into primary care, and for medication therapy management provided by pharmacists through telehealth.
  • Direct the Joint Legislative Audit and Review Commission (JLARC) to evaluate the value and impact of state-funded health care workforce scholarship and loan repayment programs.
  • Provide support to primary care practices transitioning to team-based care through the Area Health Education Centers, which are managed by the Virginia Health Workforce Development Authority.
  • Direct DMAS to develop a plan to participate in the Medicaid health home program, which provides an enhanced federal match for team-based care for Medicaid beneficiaries with chronic conditions.

Staff’s presentation on the study findings and policy options may be found at this link and the full draft report is available at this link.

Vertically integrated carriers and providers:  This study was directed to evaluate the scope of vertically-integrated carriers and providers in Virginia and nationwide and determine the effect of vertical integration on access to services, health care costs, and quality of care.  The study focused on vertical integration (a joint ownership interest) between payers and acute care hospitals.  This study did not include policy options, but public comments are being considered through the submission process detailed above.

Currently there are three vertically integrated systems in Virginia; in these systems, a hospital system fully or partially owns an insurance carrier.  Staff found no harmful effects at this time on access to care in Virginia as a result of vertical integration, as vertically integrated carriers operate in markets where there is competition.  The effect on costs is difficult to quantify; in theory, vertical integration could result in cost savings, but the report found that research is mixed on whether these cost savings are achieved or shared with plan members.  Staff found that vertically integrated providers in Virginia had higher quality ratings from the Centers for Medicare and Medicaid Services than other acute care hospitals, and that vertically integrated insurers spent more of their premium revenues on quality improvement, although their quality ratings did not differ significantly from those of other insurers.

The staff briefing on this study is available at this link and the full report is available at this link.

VACo Contact:  Katie Boyle

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