In most counties in California, the Department of Health Care Services (DHCS) contracts with one or two managed care plans (MCPs) to deliver services to Medi-Cal enrollees. In Sacramento and San Diego, DHCS contracts directly with five or more MCPs in an approach called the Geographic Managed Care (GMC) Model. It has been unclear whether this greater competition among MCPs produces better care and satisfaction among Sacramento and San Diego Medi-Cal enrollees and their providers, or whether market fragmentation leads to navigational challenges and poor coordination of care.

This report examines how quality of care, access to care, and patient satisfaction in GMC counties compare with similar urban counties that use a County Organized Health System (or COHS, a single public MCP) or the Two-Plan Model (where a public MCP and a commercial MCP compete).

Key findings include:

• Access to care for Medi-Cal enrollees in GMC counties appears to be no better than for enrollees in the comparison urban COHS and Two-Plan counties.
• The quality of care delivered by MCPs in GMC counties was lower, on average, for 22 of 30 measures compared with MCPs in the comparison counties.
• The multiplicity of MCP options under the GMC model does not clearly manifest in better patient satisfaction: Average scores for MCPs in GMC counties were higher on some satisfaction measures and lower on others.
• The multiplicity of MCPs creates a confusing patchwork of networks, providers, benefits, and services for Medi-Cal enrollees and presents many redundancies in contracting, administrative requirements, and clinical approaches to care and quality improvement for providers.

Considerations for Improvement

The authors point to numerous approaches for improvement, including:

• Demand more from participating MCPs. DHCS could use the forthcoming process to recontract with all MCPs (known as “procurement”) to raise expectations and demand more from MCPs bidding on a contract.
• Adopt positive financial incentives tied to MCP performance. Several other states have adopted such programs to foster performance improvements, whereas DHCS relies primarily on penalties for poor performance.
• Foster greater collaboration among county and state stakeholders. DHCS could commit resources to working collaboratively with county officials, consumer advocates, and MCP and provider representatives in San Diego and Sacramento to establish and advance improvement priorities and goals.

About the Authors

Len Finocchio leads the Blue Sky Consulting Group’s health care practice. He earned his doctorate in public health from the University of Michigan. Matthew Newman is a founding partner with the Blue Sky Consulting Group. He earned his master of public policy degree from Harvard University’s John F. Kennedy School of Government. Shawn Blosser leads the Blue Sky Consulting Group’s data analysis team. He earned his bachelor’s degree from Stanford University and did graduate work in economics at the University of Chicago.