Skip Ribbon Commands
Skip to main content

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.
    The health disparity reports identify health care disparities for California’s Medi-Cal managed care members and are based on focused studies conducted by the EQRO.  The reports analyze External Accountability Set (EAS) measure results reported by Medi-Cal managed care plans (MCPs) for various demographic categories.  
    HEDIS® Reports (also referred to as Performance Measurement Reports)
Last modified on: 8/29/2018 8:13 AM