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Monitoring Performance: A Dashboard of Medi-Cal Managed Care

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Monitoring Performance: A Dashboard of Medi-Cal Managed Care

Navigant Consulting

This first publicly reported dashboard of Medi-Cal managed care shows areas of strength and opportunities for improvement. A companion paper examines the performance of locally sponsored and commercial Medi-Cal plans.

December 2013

Six million Californians receive health care through the Medi-Cal managed care program. Over the past three years, the program has expanded to reach new populations, provide more services, and operate statewide. The program will expand further under the Affordable Care Act as those newly eligible for Medi-Cal, California's Medicaid program, are enrolled in managed care and as plans assume responsibility for additional covered services. With so much change to Medi-Cal managed care, interest in understanding how the program measures up has never been greater among state legislators, California Department of Health Care Services (DHCS) leadership, and the public.

Against this backdrop, the California HealthCare Foundation developed a performance dashboard for the Medi-Cal managed care program. Key indicators were selected that program officials, policymakers, consumer advocates, the media, and the public can use to quickly assess the overall performance of the program, identify areas of strength, and guide priorities for improvement. The dashboard is expected to expand as other measures become available.

Among the key findings:

  • Medi-Cal managed care performs at or above the national Medicaid median on 17 of 19 quality indicators. On the two measures for which Medi-Cal lags behind the national median — postpartum care and timeliness of prenatal care — the gap has persisted over the last four years.
  • On most measures of consumer experience, the program performs below the national Medicaid median.
  • Across all measures of quality, access, and consumer satisfaction, there are considerable differences in performance among participating plans, including significant variation in plan performance within counties.
  • Most plans participating in Medi-Cal appear to be in sound financial health. Two plans, however, have had net losses in each of the last two years.

Locally Sponsored Versus Commercial

Which type of Medi-Cal managed care plan does the best job caring for enrollees? A companion to the dashboard, Monitoring Performance: Locally Sponsored Versus Commercial Medi-Cal Plans provides an in-depth look at this particular aspect of Medi-Cal managed care.

The full report, as well as the companion issue brief, is available under Document Downloads.

Reader Comments

The major problem is the reimbursement for services rendered. At least 80% of all prescriptions under managed care Medi cal are at a loss. Reimbursement needs to cover cost, a profit and be paid timely.
Med organizations don't care about fixing the problems they only care that the mistakes are "covered up" so nobody is held accountable for the damages that were caused. July 17, 2014 Senate subcommittee hearings on medical mistakes cost taxpayers over $1 Trillion a year to fix the mistakes or as in my case I was declared totally disabled at 47 costing federal gov & Medicare $85,000 a year in medical costs and destroyed my family because I was too ill to help my bi-polar brother fight to get mental healthcare at his Kaiser plan as he was forced to stop work because of medical symptoms that his doctor failed to recognize or treat because of costs to private insurance companies. Only way medicine will improve in this country is if private insurance companies are "removed" and healthcare is put "totally" in the hands of "competent" doctors who can write "true, accurate and full" med records, not omitting all the med info which would show that the doctor made mistake/negligent.
I'm a "dual" disabled with Contra Costa Health Plan and nobody at this plan can "read"! Top of all complaint letters regarding "false, incomplete and altered medical records " after "I" was required to ask for a sleep test when every PCP doctor at Contra Costa Regional Medical Martinez Family clinic failed to order the sleep test in 2001, 2005 and March 2010 my complaint letters were all ignored, "buried" and sent to the wrong address & my last name was changed in their computer system; therefore, denying all the written specialists referrals I had received when I changed out of the Contra Costa Regional Medical Center network to the "Community Provider Network" because of MASSIVE INCOMPETENCE of "not" ordering a test for over a decade that proved in November 2010 that I had physically and mentally collapsed because I didn't receive any treatment for my Severe Obstructive Sleep Apnea that "I" had to be my own doctor, this med center sent my file to legal for "alterations". Cover-up !
It seems that the real story is the variation between health plans. What actions are being taken to address the shortcomings of those with low scores?