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A close look at Medi-Cal managed care: stories of quality improvement success
A close look at Medi-Cal managed care: stories of quality improvement success
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (California HealthCare Foundation)
- Author(s):
- Chapman, Athena, author
Evenson, Elizabeth, author
Davis, Caroline, author - Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, California] : California Health Care Foundation, September 2019
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Managed Care Programs
Medicaid
Quality of Health Care
Leadership
Quality Indicators, Health Care
Reimbursement, Incentive
State Government
Humans
California
United States - Genre(s):
- Technical Report
- Abstract:
- With more than 80% of Medi-Cal beneficiaries enrolled in managed care, assessing and monitoring the quality of care delivered by managed care plans (MCPs) is critical to ensuring all Medi-Cal members receive high-quality, timely care. Among other oversight activities, the California Department of Health Care Services (DHCS) monitors Medi-Cal MCPs' annual scores on Healthcare Effectiveness Data and Information Set (HEDIS) measures, which assess quality of care, including rates for preventive screening, control of chronic conditions, and access to primary care. A 2019 study conducted by the University of California, San Francisco analyzed HEDIS scores and trends in Medi- Cal managed care from 2009 to 2018. The study found that quality varied significantly across MCPs and regions and that, over this ten-year period, quality did not improve or declined for more than half of the measures. However, there are many examples of significant progress by individual MCPs on specific measures. In light of these findings, the California Health Care Foundation (CHCF) commissioned Chapman Consulting to examine the experiences of a subset of successful MCPs to answer two questions: First, how did the selected MCPs make real, sustained improvements in quality and achieve those gains? Second, what lessons do these experiences provide to policymakers, Medi-Cal program officials, and MCPs seeking to broaden and accelerate quality improvement in Medi-Cal managed care? The experiences of the selected MCPs point to several, interconnected strategies: leadership commitment; effective data analysis; real-time data exchange; collaborating with providers at the point of service; increasing member access to care and education; and targeted financial impediments to be addressed: carve-out services; poor data exchange; and inadequate provider supply and participation. These lists are intended not to be comprehensive but rather to shed light on what must be done to ensure all Medi-Cal enrollees receive high-quality care.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (7 pages)).
- NLM Unique ID:
- 101758696 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101758696