A Close Look at Medi-Cal Managed Care: Quality, Access, and the Provider’s Experience Under the Regional Model
Medi-Cal enrollees in 18 rural counties in California receive care under Medi-Cal’s Regional Model of managed care, in which enrollees have the option of choosing between two commercial managed care plans (MCPs), Anthem Blue Cross and California Health & Wellness. This report compares access to care, quality of care, and both patients’ and providers’ satisfaction with MCPs in Regional Model counties with (1) a “rural comparison” group of 14 other rural counties in California and (2) the “PHC north,” which includes seven of these rural comparison group counties that joined Partnership HealthPlan of California (PHC) as part of the Medi-Cal rural expansion in 2013.
Key findings include:
- Medi-Cal enrollees’ access to primary care in Regional Model counties is comparable to that in other rural regions.
- Access to specialty care is somewhat more difficult for Medi-Cal enrollees in Regional Model counties compared to other rural areas of the state.
- The quality of care provided to Medi-Cal enrollees by Regional Model MCPs was worse, on average, when compared to MCPs in other rural counties.
- Overall, Medi-Cal enrollee satisfaction with MCP performance was lower in Regional Model counties relative to other rural areas of the state.
- Many providers and county officials in Regional Model counties are concerned with the performance of the two Regional Model MCPs, although representatives of the two MCPs said they were taking steps to address the concerns.
See the full paper for how Regional Model counties compared to the PHC north.
Considerations for Improvement
Authors suggest that state policymakers and program officials should conduct additional research on the nature and extent of provider dissatisfaction and undertake careful monitoring of patient satisfaction, care quality, and health outcomes in Regional Model counties. In addition, the assessment identified several opportunities for improvement, including:
- Developing a regional health care provider recruitment strategy
- Increasing use of telehealth and other electronic mechanisms for accessing care
- Improving communication among MCPs, providers, and counties to address challenges associated with having MCPs headquartered outside of the region
- Involving DHCS or another neutral third party in discussions between MCPs and providers regarding unresolved contracting issues
- Developing and enforcing more meaningful network adequacy standards
- Requiring MCPs and their delegates to deploy a valid, reliable, and standardized provider satisfaction survey annually
About the Authors
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. Len Finocchio leads the Blue Sky Consulting Group’s health care practice. He earned his doctorate in public health from the University of Michigan. 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.