DVHA strives to ensure that the provider network is adequate to deliver the right care; at the right time to prevent Vermonters from traveling too far and to maximize member choice of provider. This is true for members within the Accountable Care Organization, and the remaining managed Medicaid population. Vermonters have a variety of health care needs and require a network of providers that can address all those needs and deliver all the covered services.
DVHA recognizes that regularly visiting a primary care provider (PCP) is beneficial for health and wellness, management of chronic disease and the reduction of overall health care costs.
Beyond ensuring that the provider network meets State and Federal requirements, DVHA must act as a gatekeeper to safeguard vulnerable Vermonters and mitigate the financial risk of fraud and abuse. DVHA conducts training and outreach to help providers understand how to properly bill so that they can get paid promptly. Training and outreach efforts also help both members and providers stay up-to-date with changes to programs.