Paying Medi-Cal managed care plans for value: quality goals for a financial incentive program

Paying Medi-Cal managed care plans for value: quality goals for a financial incentive program

Collection:
Health Policy and Services Research
Contributor(s):
Bailit Health Purchasing, issuing body.
California HealthCare Foundation, issuing body.
Publication:
[Oakland, California] : California Health Care Foundation, April 2019
Language(s):
English
Format:
Text
Subject(s):
Managed Care Programs
Medicaid
Quality of Health Care
Value-Based Purchasing
Health Workforce
Quality Indicators, Health Care
Reimbursement, Incentive
Humans
California
United States
Genre(s):
Technical Report
Abstract:
Across the country, many states are establishing clear performance expectations for their Medicaid managed care plans (MCPs) and adopting financial incentives tied to quality of care and other measures of performance. California is not one of them, despite an abundance of poor MCP scores on many measures of quality and consumer experience. Moreover, when Medi-Cal MCPs are able to reduce the cost of care, the state reduces their capitation rate--a phenomenon known as "premium slide"--even if they have improved quality of care and made health-related investments to address social determinants affecting individuals and communities. A 2018 report from the California Health Care Foundation (CHCF) provided a recommendation for a performance incentive program that would address premium slide in Medi-Cal managed care. This report picks up where that one left off. Specifically, this report provides recommendations for a measure set and performance evaluation methodology to encourage improvement in the quality of care provided to Medi-Cal beneficiaries by MCPs. These recommendations were developed over a series of four meetings with an Advisory Group representing a diverse array of Medi-Cal stakeholders, including Medi-Cal MCP leaders, consumer advocates, provider representatives, and other experts listed in Appendix A.
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 (25 pages))
Illustrations:
Illustrations
NLM Unique ID:
101758751 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/101758751