Virginia Medicaid

Studies and Reporting

The Office of Quality and Population Health strongly believes in the principle of data transparency, and uses 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).


Evaluation of Quality Improvement Activities

No less than annually, DMAS works in collaboration with its External Quality Review Organization to evaluate the effectiveness of the Quality Strategy. The evaluation has two main components. Internally, a Quality Improvement Committee (QIC) will aide in monitoring progress implementing mandatory and optional external quality review tasks. The QIC’s purpose will be to drive quality improvement by regularly monitoring progress, and recommending improvements to meet pre-determined performance metric and PIP quality targets, and will be comprised of staff across the quality, programmatic, and clinical staff within DMAS. Externally, the evaluation will be led by DMAS’s EQRO, which will result in the Annual Technical Report.

The Quality Strategy and EQR technical report are companion documents, in that Quality Strategy outline Agency goals, initiatives, and performance metrics, while the EQR report reviews the progress made on the pre-determined baseline and target information, and also provides recommendations for improving upon QI activities.

The Office of Quality and Population Health, working with its EQRO, maintains the Quality Strategy document, and is responsible for the evaluation. Evaluation findings resulting from the QIC, and CCC Plus and Medallion 4.0 program Annual Technical Reports will be posted on the DMAS Web site.



Committed to data transparency, DMAS is working to produce dashboards to highlight specific quality metrics, including NCQA HEDIS measures, to identify areas for improvement and success, to strengthen the services provided to the Commonwealth’s Medicaid. For currently available DMAS dashboards, please visit Data.


Quality Reports

The Office of Quality and Population Health, in collaboration with other DMAS divisions and programs, and working through its External Quality Review Organization, commissions various reports to cover topics such as Birth Outcomes, Foster Care utilization and services, Medicaid member consumer satisfaction with managed care services received, and to assess dental utilization among pregnant women, to name a few.

Birth Outcomes Focused Study Report

DMAS has conducted several focused studies providing quantitative information about prenatal care and associated birth outcomes among women with births paid by Title XIX or Title XXI, which include the Medicaid, Family Access to Medical Insurance Security (FAMIS), and FAMIS MOMS programs.

Birth Outcome Focused Studies reports can be found here.

Maternal and Child Health Program Resources

Foster Care Focused Study Report

DMAS has conducted several Foster Care Focused Studies, examining barriers to foster children accessing care, and developing recommendations to improve access. DMAS is committed to improving the quality and timeliness of care for these children. The DMAS Foster Care Program provides both physical and behavioral health complex services from birth to young adulthood. The Foster Care Program works to Connect children with other resources and partners focusing on the needs of foster children, works to Coordinate care and service delivery by utilizing a team approach, and ensuring the Continuation of services for those children who age-out of the program.

To access Foster Care Focused Study materials, please visit: Foster Care Presentations and Other Materials

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey

The CAHPS is a consumer satisfaction survey which has been adopted as the industry standard by NCQA and CMS to measure the quality of managed care plans. The Virginia Department of Medical Assistance Services (DMAS) requires the administration of CAHPS annually of its members in the CCC Plus, Medallion 4.0, and Family Access to Medical Insurance Security (FAMIS) programs, for members receiving health care services through fee-for-service (FFS) or managed care. More information on the CAHPS survey can be found at

More information about the DMAS FAMIS program can be found here:

Dental Utilization in Pregnant Women Study

The DMAS contracts with its External Quality Review Organization to conduct studies of dental utilization among pregnant women. The studies assess dental utilization among pregnant women in Virginia’s Medicaid and FAMIS MOMS programs. More information on DMAS’s Dental Services program can be found here.


Performance Withhold Program

At DMAS, the Office of Value Based Purchasing (OVBP) focuses on driving quality improvement at multiple levels within the health system by implementing financial and non-financial tools to incentivize improvements. One such tool is the Performance Withhold Program (PWP). Through the PWP, MCOs are held accountable for their performance in key areas such as behavioral health, chronic disease, maternity care and prevention, and must earn back a portion of their capitation payments through demonstrated performance against key metrics. The OVBP is devoted to promoting encourage high quality care and services to Virginia’s Medicaid members, thus maximizing value for healthcare dollars spent in the Commonwealth.

For more information about Value Based Purchasing, please visit: Value-Based Purchasing


Addiction and Recovery Treatment Services (ARTS)

On April 1, 2017, the DMAS launched an enhanced program focusing on addiction and recovery treatment, known as the Addiction and Recovery Treatment Services program or ARTS. The ARTS program expands access to a comprehensive continuum of addiction and recovery treatment services for Virginia Medicaid members in a wide range of programs including Medicaid, FAMIS and FAMIS MOMS, and promotes community-based addiction and recovery model to treatment. DMAS, working with its External Quality Review Organization, develops performance measures to evaluate the effectiveness of the DMAS ARTS program, including measures assessing Office-based Opioid Treatment Compliance (OBOT), Cascade of Care for Members with Opioid Use Disorder (OUD), and Concurrent Prescribing of Naloxone and High Dose Opioids among other measures.

More information regarding the ARTS program can be found here.