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The2010 HEDIS Aggregate Report for the Medi-Cal Managed Care Program is now available - CLICK HERE to download from the DHCS website.
This federally-required report presents the 2010 performance measurement results for all contracted plans (both full-risk and specialty) and compares results by plan model and in relation to state and national benchmarks. Appendix B shows trends over time for each measure. The report was prepared by Health Services Advisory Group (HSAG), DHCS's contracted External Quality Review Organization (EQRO).
The report'sExecutive Summary includes key findings and the EQRO's recommendations related to the HEDIS performance measures. You also can use the Table of Contents to locate the results for specific performance measures (such as "Childhood Immunizations" or "Comprehensive Diabetes Care") and easily see how each of the plans scored on a measure compared to one another and to state and national benchmarks. This report also includes a section onHow to Get the Most from This Report and a glossary with definitions of key terms used in HEDIS reporting.
Please let Rita Marowitz, Chief of Program Data and Performance Measurement Section, DHCS, know if you have any questions or concerns about this report. (916) 449-5140; FAX: (916) 449-5005 E-mail: Rita.Marowitz@dhcs.ca.gov
Additional plan-specific performance evaluation reports (PSERs) for 2008-2009 have been posted on the MMCD webpage CLICK HERE for the following plans:
- Anthem Blue Cross Partnership Program
- Care 1st Partner Plan
- Central California Alliance for Health
- Community Health Group Partnership Plan
- Contra Costa Health Plan
- Health Net Community Solutions
- Kern Family Health Care
- Western Health Advantage
Scroll down to the heading "2008-2009 Plan-Specific Performance Evaluations" to find these newly released reports. 2008-2009 PSERs were previously posted for: Alameda Alliance for Health, CalOptima, and Molina Healthcare of California Partner Plan. Reports for the remaining plans will be posted soon.
These federally required reports present the External Quality Review Organization’s (EQRO's) annual evaluation of plan performance related to the quality of, access to, and timeliness of care provided to Medi-Cal managed care plan members. Note that these PSERs now include more sources of information for the EQRO's evaluation. In addition to each plan's HEDIS results and Quality Improvement Projects, the EQRO also evaluated each plan's annual QI workplan and quarterly QI Committee minutes, DMHC and DHCS audit reports, and Member Rights/Program Integrity Unit review findings. The EQRO not only comments on plan strengths, but also offers recommendations regarding each plan's "opportunities for improvement."
If you have questions or comments about these reports, please contact Helen MacDonald, Chief of MMCD's Performance Measurement Unit at helen.macdonald@dhcs.ca.gov.
FYI...Click Here to see the following reports now available on the MMCD webpage under "Quality Improvement & Performance Measurement Reports"
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The QIPs Status Report: January 1, 2010 -- March 31, 2010 is now available CLICK HERE under "Quality Improvement & Performance Measurement Reports"
This report satisfies a federal quality assurance requirement and documents that the required Quality Improvement Projects (QIPs) conducted by Medi-Cal managed care plans have been externally validated by the state’s External Quality Review Organization (EQRO) in accordance with the Centers for Medicaid and Medicare protocols. Note: MMCD's current EQRO is Health Services Advisory Group (HSAG). This report describes the results of HSAG's validation of plans' QIPs proposals and annual status reports during the first quarter of 2010 and includes specific recommendations for plan improvement in QIP design and documentation. Note that the report’s appendix lists all QIPs active during that period.
- Under the “Statewide Collaborative QIP Reports” the ER Collaborative 2008-2009 Interim Report - June 2010. This interim report describes the collaborative activities conducted since the baseline report was released in October of 2009 and includes the status of statewide collaborative interventions, initial findings from QIP validation, 2007 calendar-year data, collaborative successes and challenges, as well as recommendations for the future.
- Under “Quality Improvement Project (QIP) Reports” the QIPs Status Report: April 1, 2009 – June 30, 2009 and QIPs Status Report: July 1, 2009 – September 30, 2009. It is a federally quality assurance requirement that plan Quality Improvement Projects (QIPs) are externally validated in accordance with CMS protocols regarding design and documentation. Health Services Advisory Group (HSAG) – DHCS’s External Quality Review Organization (EQRO) – is currently providing this external validation. These QIPs status reports describe the results of HSAG’s validation of plan QIPs proposals and annual status reports for the periods April 1, 2009-June 30, 2009 and July 1, 2009-September 30, 2009 and recommendations for plan improvement. As a point of reference, each report’s appendix lists all QIPs active during that period.
The 2007-2008 Plan-Specific Performance Evaluations reports for Aids Healthcare Foundation Healthcare Centers, Family Mosaic Project, and SCAN are now available on the MMCD webpage under "Quality Improvement & Performance Measurement Reports" Click Here to see reports under "2007-2008 Plan-Specific Performance Evaluations." (Scroll down to that heading.)
Note that these are the first Plan-Specific Performance Evaluations ever prepared for these three "specialty plans."
These federally required reports present the External Quality Review Organization’s (EQRO's) annual evaluation of plan performance related to the quality of, access to, and timeliness of care provided to Medi-Cal managed care plan members. These reports were prepared by DHCS’s previous EQRO, Delmarva, and present results for two years (2007-2008) combined in one report per plan.
The plan-specific performance evaluations covering July 2008 through June 2009 are being prepared by the current EQRO, Health Services Advisory Group, and are scheduled for release sometime after June 2010.
Please click HERE to access the new quality reports that have been added to the state’s Medi-Cal Managed Care Division (MMCD) webpage:
The Medi-Cal Managed Care webpage , has recently added 2007/2008 Plan-Specific Performance Evaluations for the following plans: Anthem Blue Cross, Care 1st, CenCal Health, Central Coast Alliance for Health, Health Net, Inland Empire, Kern Family Health Care, Molina, and Western Health Advantage.
These federally required reports present the annual evaluation by the External Quality Review Organiztion (EQRO) of plan performance related to the quality of, access to, and timeliness of care provided to Medi-Cal managed care plan members. These reports present results for two years combined in one report for each plan and were prepared by the previous EQRO, Delmarva Foundation for Medical Care.
Advocates are working on many issues in Medi-Cal Managed Care, some of which are:
1) Changes to packets of information sent to Medi-Cal recipients who must enroll in managed care (mandatory enrollees). Click HERE for information.
2) Pregnant women whose continuity of care is interrupted by the requirement to enroll in a Medi-Cal Managed Care plan. This can happen at various points in pregnancy, but we have worked most intensively on switching that occurs in the third trimester. Click HERE for information.
3) a telephone reminder pilot project for Medi-Cal recipients who must make a managed care choice, but who are about to default (have their plan chosen for them by the state). Click HERE for a copy of the "state's draft telephone reminder pilot project" and the June 1, 2007 advocates' comments, click HERE.
Contact us for more information: (213) 749-4261
Lynn Kersey lynnk@mchaccess.org
Please click HERE to access the new quality reports that have been added to the state’s Medi-Cal Managed Care Division (MMCD) webpage:
- On November 20, 2008, the Office of the Patient Advocate (OPA) released the 2009 version of the Health Care Quality Report Card. Plans' ratings by county are now available directly on OPA website. Note: From the OPA home page, just click on "Medi-Cal" to get to the Medi-Cal managed care quality ratings. These quality ratings for Medi-Cal Managed Care plans are the same as those currently contained in the Consumer Guides distributed to beneficiaries by Health Care Options & also available on the MMCD webpage. Previously OPA's website simply provided the link to the Consumer Guide directory page on MMCD's webpage, which required the user to then select a county & scroll through a PDF to get to the quality ratings.
- Under "Member Satisfaction Survey (CAHPS) Reports, the Results of the 2007 Consumer Assessment of Healthcare Providers and Systems (CAHPS)
for Medi-Cal Managed Care Health Plans. This report describes the results of surveys conducted with plan members in February-May 2007, including how the surveys were conducted,
the demographics of those who responded, and results by plan and by model type.
- Under "Quality Improvement Project Reports", the Quality Improvement Projects Report for 2nd Quarter 2008. This report describes all the QIPs
validated by the EQRO during April-June 2008. Details of each QIP are provided in the report's appendix. Note: this is the last quarterly QIPs status
report to be done by Delmarva.
- Under "Performance Measurement (HEDIS) Reports," the Report of the 2007 Performance Measures for Medi-Cal Managed Care Members. This annual report provides detailed results for the 12 HEDIS measures which MMCD uses to evaluate the quality, access, & timeliness of care provided to Medi-Cal managed care plan members. (This report also was delayed. The 2008 HEDIS report is expected to be released on time this year.)
- Under "Quality Improvement Project Reports," the QIPS Status Report for 1st Quarter 2008. This report describes all the Quality Improvement Projects validated by the MMCD’s contracted External Quality Review Organization during Jan-Mar 2008. Details of each QIP are provided in the report's appendix.
During March through May 2010, DHCS's contracted External Quality Review Organization, Health Services Advisory Group (HSAG), will conduct the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for adult and child members of all contracted Medi-Cal managed care plans (excluding specialty plans). Surveys are not sent to all plan members, but rather to a sample of members selected in accordance with National Committee for Quality Assurance specifications. Surveys are available in English and Spanish.
The first mailing date is scheduled for March 2, 2010. For your reference attached is the initial survey letter that members will receive with the surveys. The survey vendor also will conduct mail and telephone follow-up. The State Medi-Cal Managed Care Division will release a summary report of the survey results on the Medi-Cal Managed Care Division’s webpage in early 2011, although plans will receive detailed plan-specific results before the aggregate report is released.
As you will note in the survey letter, the survey vendor provides a toll-free help line that members can call if they have questions about the survey or need help completing it. Medi-Cal Managed Care has learned from past surveys that some members will call this number with specific questions regarding their managed care plan that cannot be answered by the survey vendor. In these situations, the survey vendor will provide the member with the toll-free number for MMCD's Office of the Ombudsman (1-888-452-8609).
The Medi-Cal Managed Care Division wanted you to be aware that CAHPS will be underway during March through May since the mailings could result in some phone calls to plans or advocates. Please feel free to contact Helen MacDonald, Chief, Performance Measurement Unit, with questions or concerns. Her phone number is (916) 449-5146 and e-mail Helen.MacDonald@dhcs.ca.gov.
Advocates are working on
two issues in Medi-Cal Managed Care: changes to
packets of information sent
to Medi-Cal recipients who must enroll in managed care (mandatory enrollees)
and a telephone reminder pilot project for Medi-Cal recipients who must make
a managed care choice, but who are
about to default (have their plan chosen
for them by the state). Click HERE for a copy of the "state's draft telephone reminder
pilot project" and the June 1, 2007 advocates' comments, click HERE.
Contact us for more
information: (213) 749-4261
Lynn Kersey lynnk@mchaccess.org
Celia Valdez celiav@mchaccess.org
Liz Ramirez lizr@mchaccess.org
Donald Nollar donaldn@mchaccess.org |
