Medi-Cal Managed Care Quality Improvement 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.
Medi-Cal Managed Care Quality Strategy Reports
The
Medi-Cal Managed Care Quality Strategy Reports are DHCS' written strategy for assessing and improving the quality of managed care services offered by all Medi-Cal MCPs.
Member Satisfaction Surveys (CAHPS® Surveys)
Each
Consumer Assessment of Healthcare Providers and Systems (CAHPS®) 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 Study Reports
Encounter Data Validation (EDV) Study Reports examine the completeness and accuracy of the encounter data submitted to DHCS by the MCPs.
Managed Care Accountability Sets / External Accountability Sets
The
Managed Care Accountability Sets (MCAS) / External Accountability Set (EAS) is a set of performance measures that DHCS selects for annual reporting by Medi-Cal MCPs.
External Quality Review Technical Reports and Plan-Specific Evaluation Reports
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.
Access these reports on the
Medi-Cal Managed Care External Quality Review Technical Reports with Plan-Specific Evaluation Reports.
Health Disparity Reports
The
Health Disparity Reports identify
and
understand health disparities affecting California’s Medi-Cal managed
care members and are based on focused studies conducted annually by the EQRO.
The reports analyze Managed Care Accountability Set (MCAS) measure results
reported by Medi-Cal managed care plans (MCPs) for various demographic
categories.
HEDIS® Reports
The
Healthcare Effectiveness Data and Information Set (HEDIS®) Aggregate Report, also referred to as Performance Measurement Reports, 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
The MCP-Specific Performance Evaluation Reports are also referred to as Plan-Specific Performance Evaluation Reports.
Access these reports on the Medi-Cal Managed Care Quality Improvement Reports webpage
Performance Measures and HEDIS® Reports
Access Medi-Cal Managed Care’s annual performance measure, External Accountability Set, on the
Medi-Cal Managed Care Quality Improvement Reports webpage.
The following performance measure results are also available on our website:
Performance Improvement Project Reports
Plan-Specific Performance Evaluation Reports
Plan-Specific Performance Evaluation Reports are also referred to as MCP-Specific Performance Evaluation Reports.
Access the reports on the
Medi-Cal Managed Care Quality Improvement Reports: External Quality Review Technical Reports and Plan-Specific Evaluation Reports.
Quality Improvement Project Reports
Quality Improvement Project (QIP) Reports are available on the
Medi-Cal Managed Care Quality Improvement Reports: Quality Improvement Project Reports webpage.
Technical Reports
Technical Reports are available on the Medi-Cal Managed Care Quality Improvement Reports: External Quality Review Technical Reports webpage.
Preventive Services Report
The 2021 Preventive Services Report and Executive Summary identify and monitor appropriate utilization of preventive services for children in Medi-Cal managed care.
The 2020 Preventive Services Report and Addendum assesses the
provision of preventive services by pediatric Medi-Cal managed care members.
