Research Consortium Reports – Virginia Center for Health Innovation

Benchmarking Preventive Care Medicaid Rates to Private Payers

Authored by Meredith Young, MNSP, Alison Evans Cuellar, PhD, MBA, and Jennifer M Mellor, PhD.

Published in JAMA Health Forum on September 4, 2026.

This study provides state-specific information on how Medicaid reimbursement for preventive care compared with other payers in Virginia in 2023. In contrast with previous studies, we combined TiC data with paid claims data to remove many ghost rates and make more accurate comparisons across payers.

On average, Medicaid MCOs reimbursed preventive care services at higher rates than Medicaid FFS, although there was evidence of rate variation across Medicaid plans and geographic areas. In addition, both ESI and Marketplace plans had reimbursement rates well above Medicaid MCOs and even MA payers, with Marketplace reporting the highest mean rates.

Trends and Disparities in High-Risk Nonsteroidal Anti-Inflammatory Drug Utilization

Authored by Michelle Rockwell, Christopher Grubb, Jamie Turner, Matthew Vinson, Isaiah Yim, Alexandra Hanlon, and John Epling.

Published in the American Journal of Managed Care on August 7, 2026.

A quasi-experimental difference-in-differences analysis of Virginia claims quantified NSAID dispensing in higher-risk cardiorenal populations across 2019–2021 and estimated pandemic-associated utilization changes using Poisson regression.

Dispensed NSAID prescriptions were estimated at 3.8 million statewide, and utilization fell 23% during March 2020–December 2021 compared with prepandemic trends.

Rural residence was associated with higher utilization than urban residence (IRR 1.594; 95% CI 1.408–1.803), indicating persistent geographic disparities in potentially nephrotoxic prescribing.

Optimizing the Uptake and Completion of the Cervical Cancer Screening Continuum: Opportunity Knocks, Including at Home

Authored by Michelle S. Rockwell and A. Mark Fendrick.

Published in Cancer Epidemiology, Biomarkers & Prevention on July 1, 2026.

Despite decades of evidence demonstrating that cervical cancer screening prevents morbidity and mortality, approximately one in four eligible Americans remains overdue for screening. Screening gaps are unevenly distributed, disproportionately affecting uninsured individuals, those with lower income or educational attainment, rural residents, and racial and ethnic minority populations. In this commentary, we highlight that perceived out-of-pocket costs for cervical cancer screening-rather than actual costs-remain a salient and modifiable barrier to screening among low-income, underscreened women, even in the context of Affordable Care Act (ACA) provisions.

RD678 Virginia Task Force on Primary Care Update on Research Activities October 2025

Published on the Reports to the General Assembly website, part of the Legislative Information System in October 2025.

Following the appropriation of funds and execution of contracts with DMAS in May 2025, the Research Consortium, on behalf of the Task Force, has provided eight individual research products to the Department to support Medicaid policy in primary care.

State Medicaid Policy Options for Primary Care

Drafted by Lauryn Walker on behalf of the Virginia Task Force on Primary Care.

Preliminary findings released June 30th, 2025.

Medicaid has several policy levers to support high quality primary care, ranging greatly in complexity and cost. This brief landscape review is aimed at describing key policy options and the various benefits or challenges associated with each. This review is not intended to describe all possible policy levers used by every state, but instead major strategies that could be leveraged. This report should not be seen as an endorsement of any specific policy option on behalf of the Virginia Task Force on Primary Care.
Authorities described in this report are generally ordered from most complex to least complex to execute from the perspective of the state Medicaid agency. Complexity also may be paired with additional flexibility to use federal funds for novel purposes.

Virginia Task Force on Primary Care Update on Research Activities

Reported to Virginia Department of Medical Assistance Services (DMAS) on October 1, 2025.

Per the 2024 recommendation of the Virginia Task Force on Primary Care (Task Force), the Virginia Center for Health Innovation (VCHI) launched the Research Consortium at VCHI. This Consortium was established to enable the Task Force and VCHI to produce timely, rigorous, and actionable research for the Department of Medical Assistance Services (DMAS) and other state partners to guide primary care and health policy.
Following the appropriation of funds and execution of contracts with DMAS in May 2025, the Research Consortium, on behalf of the Task Force, has provided eight individual research products to the Department to support Medicaid policy in primary care.

Neighborhood Determinants of Primary Care Access in Virginia

Authored by Hannah M Shadowen, Jennifer L Gilbert, Benjamin Webel, Adam Funk, Jong Hyung Lee, Scott M Strayer, Roy T Sabo, Lauryn S Walker, Michael Topmiller, Andrew Mitchell, Jacqueline B Britz, Andrew J Barnes, and Alex H Krist.

Published by the National Library of Medicine on May 27th, 2025.

Primary care is the foundation of any health care system. Yet, workforce shortages have worsened in the United States. Understanding characteristics of where workforce gaps are greatest is key to developing effective workforce solutions. We used the 2019 Virginia All-Payers Claims Database to identify primary care physicians (PCPs) and the number of distinct patients seen by each physician. In Virginia, 56.0% of census tracts had adequate PCP access. No association was found between PCP access and predisposing factors. Multiple enabling factors (ie, marital status, education, English language proficiency) were significantly associated with PCP access.

Measles Outbreaks & Vaccine Policy

Authored by Emma Ford, MPP, and Lauryn Walker, PhD, for VCHI’s Capitols to Commonwealth blog series.

Published March 7th, 2025. Updated March 11th, 2025.

Since the beginning of 2025, the Centers for Disease Control (CDC) has reported 3 measles outbreaks, totaling 222 cases and 2 deaths, with 95% of these cases occurring among unvaccinated individuals. By far the largest outbreak is currently occurring in Texas, where the Texas Department of Health and Human Services reports an ongoing outbreak with 159 individuals infected, 22 hospitalized and one fatality, and an additional outbreak in nearby Lea County, New Mexico where there have been 10 reported cases and 1 death. There are currently no reported cases in Virginia, although Virginia did have multiple smaller outbreaks in 2024.

Medicaid and the Budget Debate

Authored by Lauryn Walker, PhD for VCHI’s Capitols to Commonwealth blog series.

Published February 28th, 2025.

On Tuesday, February 25, the U.S. House of Representatives voted 217 – 215 to pass the Budget Resolution proposed by House Republicans, which includes $1.5 trillion in spending cuts over 10 years. Separately, the Senate passed its own budget framework last week, which includes two separate bills, the first of which increases spending by $342 billion.

Is Virginia’s Medicaid Expansion Really in Jeopardy?

Authored by Lauryn Walker, PhD, for VCHI’s Capitols to Commonwealth blog series.

Published February 20th, 2025. Updated February 24th, 2025.

Potentially. Congress is currently debating a proposal to reduce the federal match for the Medicaid expansion population (adults up to 138% of the federal poverty line). If passed, Virginia’s current budget requires that all expansion enrollees be disenrolled. The Virginia State Senate has included language in their proposed budget that would require a special committee meeting to address policy options before disenrollments begins. No such amendment was proposed in the House.

Disparities in Substance Use Disorder Telehealth Services

Authored by Lauryn Saxe Walker, PhD, MPH, Manying Cui, MS, Jonathan Cantor, PhD, Melody Craff, PhD, MBA, Cheryl L. Damberg, PhD, John N. Mafi, MD, MPH, AND Katherine L. Kahn, MD.

Published in JAMA Open Network on February 12th, 2025.

Telehealth has become a critical modality for substance use disorder treatment (SUDT) and focus of state and federal policy.Telehealth offers the potential to decrease disparities in SUDT for Medicaid and rural populations by reducing challenges with transportation and workforce shortage areas. Using nationwide claims data throughout the COVID-19 public health emergency (PHE), we examine telehealth’s association with changes in disparities in SUDT utilization across payers and rurality.

Increased spending on low-value care during the COVID-19 pandemic in Virginia

Authored by Michelle S Rockwell, Sitaram Vangala, Jillian Rider, Beth Bortz, Kyle Russell, Marcos Dachary, Lauryn Walker, A Mark Fendrick, and John N Mafi.

Published in Health Affairs Scholar on October 23rd, 2025.

Defining the State Role in Primary Care Reform

Authored by Lauryn Walker, Lisa Dulsky Watkins, and Christoper F. Koller.

Published by Milbank Memorial Fund in May 2024.

Six activities can help states optimize their authority to improve primary care.
Providing data transparency on the health of primary care at the state and local level is a first responsibility, followed closely by building a coalition.

It Takes Two to Tango: Creating an Effective State–Federal Partnership for Primary Care Reform

Authored by Lauryn Walker, Shannon Dowler, Barbra Rabson, and Bob Rauner.

Published by Milbank Memorial Fund in May 2024.

Seven ways that the federal government can support states in strengthening primary care.
A federal vision for primary care will help states optimize their role in reform.