Monitoring Performance in Medi-Cal

CHCF monitors how well the Medi-Cal program is delivering timely and high-quality care to its enrolles. Given the large number of people of color enrolled in the program, improving access and quality in Medi-Cal is essential to California's ability to achieve health equity.

Around 80% of Medi-Cal members are enrolled in a Medi-Cal managed care plan. CHCF has focused on tracking trends in the quality of care overseen by these plans. It has also closely followed the state’s recent process to select and write new contracts with Medi-Cal managed care plans, noting the once-in-a-decade opportunity to hold these plans to higher standards for access and quality.

Six Things to Watch For Now That Medi-Cal Has Picked Commercial Managed Care Plans

September 8, 2022

Christopher Perrone

Health Equity, Medi-Cal

Continued investment and sound implementation will lead to higher quality care for millions of Medi-Cal enrollees — and progress toward reducing racial and ethnic disparities in outcomes.

Medi-Cal Quality Strategy Explores Bold Steps Toward Health Equity

January 26, 2022

Christopher Perrone

The strategy will shape how health care will be provided to almost one in three Californians.

Webinar — Organizations React to Medi-Cal Managed Care Procurement Draft RFP

Medi-Cal, Payment & Financing

CHCF’s webinar on August 5 from noon to 1:15 PM (PT) highlighted the feedback provided to DHCS from various organizations on the Medi-Cal managed care procurement draft RFP.

Measuring Up? Access to Care in Medi-Cal Compared to Other Types of Health Insurance (2018)

UCLA Center for Health Policy Research

This report examines if Medi-Cal enrollees face greater difficulty accessing health care services than Californians with employer-sponsored insurance or coverage purchased through the individual market.

Health Disparities Require Bolder Action on Medi-Cal Managed Care Contracts

Christopher Perrone

Health Equity, Medi-Cal, Payment & Financing

The draft RFP for Medi-Cal managed care procurement is a significant step forward, but California must do more to eliminate disparities in access and outcomes

A Golden Opportunity to Narrow California’s Racial Health Disparities

The Los Angeles Times Editorial Board

Medi-Cal, Payment & Financing

The state now has a rare opportunity to force health insurers to do more to improve the care that people with low incomes receive through Medi-Cal.

Medi-Cal: California Has a Rare Opportunity to Improve Health Care Equity

Sandra R. Hernández

Medi-Cal, Payment & Financing

About 10 million Californians get their health care through a Medi-Cal managed care plan, but the state's contracts with those plans fail to ensure that these enrollees get the high-quality care they deserve.

A Close Look at Medi-Cal Managed Care: Quality, Access, and the Provider's Experience Under Geographic Managed Care

Blue Sky Consulting Group

This report explores quality of care, access to care, and patient satisfaction for Medi-Cal enrollees in counties that use the Geographic Managed Care Model, which uses five or more Medi-Cal managed care plans (MCPs) to deliver services. Results are compared to similar urban counties that rely on only one or two MCPs.

A Close Look at Medi-Cal Managed Care: Quality, Access, and the Provider’s Experience Under the Regional Model

Blue Sky Consulting Group

Medi-Cal enrollees in 18 rural counties in California receive care under Medi-Cal’s Regional Model of managed care. This report compares access to care, quality of care, and both patients’ and providers’ satisfaction in Regional Model counties with other rural counties across the state.

A Close Look at Medi-Cal Managed Care: Statewide Quality Trends from the Last Decade

Philip R. Lee Institute for Health Policy Studies at UCSF

This report examines the quality of care provided by Medi-Cal managed care plans between 2009 and 2018. In addition to reporting on overall trends in performance, this report also examines differences by type of ownership (public, nonprofit, for-profit) and model of managed care.

A Close Look at Medi-Cal Managed Care: Stories of Quality Improvement Success

Athena Chapman, Caroline Davis

This paper highlights examples of Medi-Cal managed care plans that have made significant progress on individual quality-of-care measures. The paper identifies several common, interconnected strategies that were key to improving quality and provides concrete examples of how plans put these strategies into place.

California Map: Quality in Medi-Cal Managed Care, County by County

Use this interactive map to learn more about the quality of care provided by local Medi-Cal managed care plans in your area between 2009 and 2018.

Accountability in the Medi-Cal Managed Care Program

This fact sheet provides an overview of how the Department of Health Care Services assesses quality of care provided by the more than 30 full-service and specialty managed care plans that participate in Medi-Cal's managed care program.

How California Can Use Purchasing Power and Oversight to Improve Quality in Medi-Cal Managed Care

Medi-Cal, Payment & Financing

This paper recommends how the California Department of Health Care Services can strengthen its purchasing strategy and oversight to drive quality improvement in Medi-Cal managed care.

Paying Medi-Cal Managed Care Plans for Value

Many states use financial incentives tied to quality of care and other measures of performance in their Medicaid managed care programs. This paper outlines a measure set and performance evaluation methodology that California could use as part of a financial incentive program to drive quality improvement in Medi-Cal managed care.

Paying Medi-Cal Managed Care Plans for Value: Design Recommendations for a Quality Incentive Program

Medi-Cal, Payment & Financing

This report recommends a new way to pay Medi-Cal managed care plans (MCPs) designed to improve the quality of care for Medi-Cal enrollees. The Department of Health Care Services would withhold part of its capitation payments to MCPs, who could earn back some or all of the amount withheld depending on their performance on quality measures.

Making Quality Matter in Medi-Cal Managed Care

This report describes approaches many states are taking to use financial incentives with Medicaid managed care plans to accelerate quality improvements. There is an opportunity to build on current quality improvement efforts in Medi-Cal managed care, led by the California Department of Health Care Services, through financial incentives.

It's Time to Pay Medi-Cal Plans Differently

Medi-Cal, Payment & Financing

On February 27, 2019, Chris Perrone, director of Improving Access at CHCF, testified before the California Senate Committee on Health during an informational hearing on "Improving Performance and Aligning Incentives in Commercial Health Insurance and Medi-Cal." Read his testimony.