Medi-Cal Managed Care Task Forces and Workgroups

MMCD has organized various on-going collaborative workgroups to ensure that stakeholders have ample opportunity to advise, provide input and make recommendations regarding program services, operational issues and areas for quality improvement. MMCD currently conducts the following Stakeholder Workgroups

Advisory Workgroup

Department of Health Care Services/Department of Managed Health Care Medical Audits Committee

Facility Site Review Workgroup 

Health Education Workgroup

Medical Directors Workgroup

Pharmacy Directors Workgroup

Quality Improve Workgroup

State Hearing Quality Circle

Advisory WorkGroup

MMCD facilitates quarterly meetings with plan representatives and consumer advocacy representatives to discuss a wide array of issues, including quality of care. Meetings provide an opportunity for MMCD staff to provide program updates and for stakeholders to raise concerns about issues that affect enrolled members.  As an aid to these quarterly meetings MMCD shares various informative quarterly reports.  These reports help both MMCD and the health plans to further improve the quality of care.

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Dept. of Health Care Services/Dept. of Managed Health Care Medical Audits Committee

MMCD organizes quarterly multi-agency in-person meetings to plan and discuss issues related to collaborative joint audits of health plans. These meetings, jointly held by the DHCS and the Medical Audits Committee (DMAC) of the Department of Managed Health Care (DMHC), include participants from the agencies (DHCS and DMHC) that conduct the joint medical audits and other stakeholders (Managed Risk Medical Insurance Board’s Healthy Families Program and DHCS’s Office of Long Term Care). MMCD clinical staff and DHCS’s Audits and Investigations clinical and audit staff meet as a subgroup for in-depth discussions of specific medical issues.

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Facility Site Review (FSR) Workgroup

Plans must complete initial full scope site reviews on all primary care provider sites that have not been previously reviewed and then every three years on an ongoing basis. Registered nurses serving as FSR Master Trainers from each plan and MMCD meet in person quarterly to address FSR issues, such as policy revision, interrater reliability methods for medical record and physical site scoring, problem solving strategies related to oversight and monitoring and reviewer training and certification needs. Since May 2008, the FSR Policy Revision Task Force, a subcommittee of the FSR Workgroup which is composed of plan master trainers, medical directors and MMCD clinical professionals, has held periodic teleconferences to update the FSR policy, review tools and reviewer guidelines. The workgroup expects to complete this work in June or July 2010.

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Health Education Workgroup

Health educators from each plan meet in person quarterly with MMCD health education staff to address issues related to health education, behavioral risk assessments, group needs assessment, and other topics related to improving the quality of health education services provided to enrolled members. Since May 2008, the workgroup has established several task force groups to revise the Staying Healthy Behavioral Risk Assessment Tool and implement provider and member surveys regarding use of the tool.

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Medical Directors Workgroup

Plan medical directors are responsible for overseeing and rendering decisions related to clinical services, provision of medical care, and healthcare quality improvement. Medical directors meet quarterly with MMCD’s Chief Medical Consultant and other clinical staff to address and problem solve a wide range of health care topics including clinical services, specific health conditions, program benefits, coordination of services, provider issues, health care policy and legislation, and budgetary constraints. These meetings have included presentations by representatives from various state and private programs and agencies including the California Department of Public Health; the Medi-Cal Fee-for-Service program; the California Children’s Services; the Women, Infant and Children’s Supplemental Food Program; researchers and clinicians from learning institutions; the California Medical Association; and plan medical directors.

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Pharmacy Directors Workgroup

Plan pharmacy directors meet quarterly with the MMCD pharmacy consultant to discuss pharmacy issues. One responsibility of plan pharmacy directors is oversight of plan formularies to assure medication access meets all medically necessary needs of Medi-Cal managed care members and that access is comparable to and consistent with the Medi-Cal FFS pharmacy services benefit.

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Quality Improvement Workgroup

Managers in the areas of quality improvement and performance measurement and medical directors from Medi-Cal managed care plans participate in periodic teleconferences, generally held quarterly. Participants, including MMCD staff, discuss issues specifically related to current and future quality improvement strategies, required and proposed performance measures, plan-specific and collaborative QIPs, and other activities related to quality improvement within the Medi- Cal managed care program.

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State Hearings Quality Circle

The MMCD Office of the Ombudsman and the California Department of Social Services (CDSS) state hearings staff hold quarterly meetings, chaired by the presiding judge of the CDSS State Hearing Division Sacramento Region, to improve the quality and efficiency of the state hearing process. This is a forum for MMCD and CDSS to support open communication, address state hearing problems, and resolve member issues.