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Medi-Cal Managed Care - Quality Improvement & Performance Measurement Reports

    In accordance with federal requirements, the California Department of Health Care Services (DHCS) contracts with an external quality review organization (EQRO) to conduct external quality reviews and evaluate the care provided to beneficiaries by Medi-Cal managed care health plans (MCPs) in the areas of quality, access, and timeliness.  The EQRO presents these external quality review activities, results, and assessments in reports that help DHCS and Medi-Cal MCPs understand where to focus resources to further improve the quality of care.
    DHCS’s written strategy for assessing and improving the quality of managed care services offered by all Medi-Cal MCPs.
    Beneficiary Satisfaction Surveys, see CAHPS® Survey Reports.
    Each CAHPS® (Consumer Assessment of Healthcare Providers and Systems) survey report aggregates the results of CAHPS® surveys, which ask Medi-Cal managed care beneficiaries to evaluate their experiences with their health care health care providers.
    Encounter Data Validation (EDV) Study Reports examine the completeness and accuracy of the encounter data submitted to DHCS by the MCPs.
    The External Accountability Set (EAS) is a set of performance measures that DHCS selects for annual reporting by Medi-Cal MCPs.
    The EQRO annually prepares an independent external quality review technical report that analyzes and evaluates aggregated information on the health care services provided by Medi-Cal MCPs.  As part of the external quality review technical report, the EQRO prepares a plan-specific evaluation report of each of MCP.
    HEDIS® Reports (also referred to as Performance Measurement Reports)
    The Healthcare Effectiveness Data and Information Set (HEDIS®) Aggregate Report provides performance rates of MCPs during a reporting year and trending using previous years’ data.  The report also compares plan-specific and aggregated rates to national benchmarks.
    MCP-Specific Performance Evaluation Reports, also referred to as Plan-Specific Performance Evaluation Reports.  See External Quality Review Technical Reports and Plan-Specific Evaluation Reports.
    Performance Measures and HEDIS® Reports
    • For Medi-Cal managed care’s annual performance measure set, see External Accountability Sets
    • For performance measure results, see:
      • HEDIS® Reports for results of reporting years (RYs) 1999 through 2015.  RY 2015 was the last HEDIS® report issued separately from the External Quality Review Technical Reports.
      • External Quality Review Technical Reports for results after RY 2015, performance measure results, including HEDIS® measures.
    Performance Improvement Project (PIP) Reports, previously known as “Quality Improvement Project (QIP) Reports”.
    Plan-Specific Performance Evaluation Reports, also referred to as MCP-Specific Performance Evaluation Reports.  See External Quality Review Technical Reports and Plan-Specific Evaluation Reports.
    Quality Improvement Project (QIP) Reports, see Performance Improvement Project (PIP) Reports
Last modified on: 4/20/2016 9:19 AM