Quality Measures & Reporting
DHCS monitors the quality of care provided to its members in a number of ways. Below are links to different types of reports that have been developed to monitor DHCS programs and the quality of care provided to our members.
The reports below provide quality measures based on administrative and clinical data such as the Healthcare Effectiveness Data and Information Set (HEDIS) measures and self-reported data such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.
The Affordable Care Act (Section 1139B) requires the Secretary of Health and Human Services to identify and publish a core set of health care quality measures for adult and children Medicaid enrollees. DHCS voluntarily reported many of these measures to CMS.
- Medi-Cal Managed Care Quality Improvement and Performance Measurement Reports
Includes various quarterly and annual reports which assess managed care plan results in required quality improvement and performance measurement activities
- Mental Health Program Reports
The DHCS Mental Health Services provides reports including Medi-Cal Trend Reports, Utilization Reports, and the Behavioral Health Services Assessment Plan
- Neonatal Quality Improvement Initiative
DHCS’ Children’s Medical Services (CMS) Branch and the California Children’s Hospital Association (CCHA) are jointly sponsoring a statewide Neonatal Quality Improvement Initiative (NQI), which began September 2006 and includes an experienced multidisciplinary project team working to improve neonatal care by reducing/eliminating catheter associated blood stream infections (CABSIs) and other hospital-acquired infections in Neonatal Intensive Care Units (NICUs)
- Quality of Care Measures in Foster Care
Includes five behavioral health HEDIS measures for children in Medi-Cal and children in Foster Care for 2012, 2013 and 2014.
DHCS performs and publishes reports that monitor key transitions and changes in compliance with Centers for Medicare and Medicaid Services (CMS) and California legislative requirements.
External Quality Review Organizations (EQRO)
CMS regulations, published in January 2003, require that states which contract with Medicaid Managed Care Organizations (MCO) or Prepaid Inpatient Health Plans (PIHP) conduct an External Quality Review (EQR) of each entity. States may perform EQR tasks directly, or may contract with independent entities called External Quality Review Organizations (EQRO) to conduct the external quality review.
- DHCS Medi-Cal Managed Care Division contracts with Health Services Advisory Group (HSAG) (Not DHCS) to provide EQRO services for Medi-Cal Managed Care Plans.
- DHCS Mental Health Services Division contracts with Behavioral Health Concepts, Inc. (BHC) to provide EQRO services for Mental Health Plans.
DHCS publishes a number of descriptive reports about the programs and populations served, including Fiscal Estimates, Managed Care Reports, Quality Measures, Rates and Statistics Reports.