Monitoring Medi-Cal: Recommendations for Measuring the Performance of California's Medicaid Program

Bailit Health Purchasing

Medi-Cal covers one in five Californians. How best to monitor the performance of the state's largest insurer? This report recommends a "dashboard" to manage the program and provide accountability.

January 2011

Medi-Cal pays for the health care of 7.7 million people — more than any other Medicaid program in the nation. It is also the largest insurer in the state, covering one in five Californians and generating annual expenditures that are expected to top $50 billion in 2011.

Yet despite Medi-Cal's size and significance, its performance has gone largely unmeasured. In 2007, the California HealthCare Foundation, working with leadership of the California Department of Health Care Services, undertook a project to investigate the potential usefulness of a data framework, or "dashboard," that could:

  • Reflect how well Medi-Cal serves its beneficiaries and California taxpayers, as well as the integral role it plays in the overall health care delivery system
  • Balance the interests of program officials, policymakers, and stakeholders by providing a clear summary of program performance without sacrificing depth
  • Apply measures to the different population groups, services, and programs that are able to reflect the importance of each of these performance categories

This report presents the study's findings and recommendations, as well as a series of steps California could take to develop such a dashboard.

The complete text is available as a Document Download.

Reader Comments

Medi-Cal from my first hand knowledge has been measured by many dashboards at all levels since they were created as a tool for management and I suspect those who manage MediCal would disagree with your statement that "Yet despite Medi-Cal’s size and importance, its performance has gone largely unmeasured." If this is true we would have to assume a great deal of incompetence in CHHS and DHCS. The lack of metrics has not been the issue. It has been having meaingful metrics that create knowledge to assist in designing and managing the program. With all of the stakeholders being loudly represented, innovation has been hard to implement. Benefit and eligibility expansion has been the "will of the people" and accounts for the fiscal performance of the social program. Rob MD
The comments illustrate how difficult it was for the authors to select a small number of measures, why it is important to solicit feedback from a broad range of stakeholders, and the limitations of a dashboard to tell us everything we want to know about the program.

In stating that the dashboard would serve to illustrate "how well" Medi-Cal is serving its beneficiaries and California taxpayers, the authors were not taking the position that it is serving them well. It could very well show that the program is working well in some areas and poorly in others.

- Chris Perrone, Deputy Director of the CHCF Health Reform & Public Programs Initiative
I find the comments by these authors ironic or just revealing. Medi-Cal (DHCS or State of California) spend nearly $50B for 7.7 Million people paid for by directly or indirectly by compassionate tax payer money. The authors ask us to reflect “how well Medi-Cal has served California Taxpayers” when they declare that since 1966 (my words) that the program’s “‘…performance has gone largely unmeasured.”

They recommend a relevant dashboard to measure the performance of the Medicaid Program (and its managers-my words). Programs do not occur in a vacuum, people and how they implement and manage are often the focus of well designed dashboards (measuring interim progress) and scorecards (measuring relevant goals that matter).
Without such tools, alignment of resources and accountability is near impossible. How not measuring the program for 50+ years is a positive to California taxpayers eludes me.
Medi-Cal prenatal recommendations ignore screening for substance exposure--which affects over 60,000 births annually in CA. Potentially one of the highest-payoff preventive care items, with more than half of all births now covered by Medi-Cal. Why not use that leverage to improve birth outcomes, and avoid lifetime effects of prenatal substance exposure?
This is an excellent plan. Am wondering where dental care fits in? Would love to see that in the measures even if adult doesn't come back.