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Paying Medi-Cal Managed Care plans for value: design recommendations for a quality incentive program
Paying Medi-Cal Managed Care plans for value: design recommendations for a quality incentive program
- Collection:
- Health Policy and Services Research
- Author(s):
- Zayhowski, Justine, author
Sayles, Jennifer N., author
Bailit, Michael, author - Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, CA] : California Health Care Foundation, January 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Managed Care Programs
Medicaid -- organization & administration
Quality Assurance, Health Care
California
United States - Genre(s):
- Technical Report
- Abstract:
- Medi-Cal, California’s Medicaid program, is the state’s health insurance program for Californians with low incomes, including over 40% of all children, half of those with disabilities, over a million seniors, and around one in six workers. In total, Medi-Cal covers more than 12 million people, or nearly one in three Californians. More than 80% of Medi-Cal enrollees get their care through a Medi-Cal managed care plan (MCP).1 Every person enrolled in Medi-Cal managed care should have access to high-quality care. Currently, the California Department of Health Services (DHCS), the state agency that runs Medi-Cal, contracts with 24 full-scope MCPs responsible for providing health care, including behavioral health services to those with mild to moderate mental illness. The quality of care provided to Medi-Cal managed care enrollees is, on average, below that received by Medicaid enrollees in many other states.2 In addition, external evaluations have found that DHCS has not generated significant quality improvement gains in Medi-Cal over the past 10 years and that millions of children have not received the recommended preventive services to which they are entitled in the Medi-Cal managed care delivery system.3 Soon after these evaluation findings were shared, DHCS adopted new rules that require MCPs to perform at least as well as 50% of Medicaid plans nationally (up from 25%). In 2019, before the coronavirus pandemic, DHCS planned to require that MCPs performing below this national median be subject to a financial penalty and be required to complete a corrective action plan and quality improvement work beginning in 2020. Implementation of this policy change was delayed due to the pandemic. Stakeholders expressed mixed reactions to this change. Some applauded the change and urged further steps to ensure that quality would improve for all Medi-Cal enrollees in managed care, while many MCP representatives expressed concern that the expectation that all MCPs perform “above average” is unreasonable, and the financial consequences are too extreme. In response to these reactions and with a desire to improve MCP quality performance, DHCS and the California Health Care Foundation (CHCF) partnered on a project to explore alternative approaches to improve the quality of care provided to Medi-Cal managed care enrollees. CHCF contracted with Bailit Health to research quality incentive methodologies used by California public purchasers and other states’ Medicaid programs, interview DHCS staff and stakeholders about DHCS’s approach to MCP quality and alternative approaches, and work with DHCS staff and an Advisory Committee to support the development of recommendations. This report presents Bailit Health’s recommendations, which call for DHCS to adopt a redesigned quality incentive strategy that aims to improve the provision of quality care for Medi-Cal enrollees by increasing Medi-Cal MCP motivation and accountability for quality performance. DHCS should use a combination of coordinated and aligned financial and nonfinancial incentives.
- 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 (31 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918351269806676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918351269806676