Back to December 2021 Stakeholder Communications Update

Managed Care Performance Monitoring Dashboard Report

The October release of the Managed Care Performance Monitoring Dashboard was published on the California Health & Human Services Agency Open Data Portal on November 1. The dashboard is a monitoring tool produced quarterly that includes comprehensive data on a variety of measures, such as enrollment, health care utilization, appeals and grievances, network adequacy, and quality of care. Information in the dashboard assists DHCS and its stakeholders with observing and understanding MCP performance statewide. The October release reports on monthly enrollment, demographics, and hearings totals from April 2020 to March 2021, monthly utilization totals from October 2019 to September 2020, and quarterly grievance totals from mid-2019 to early 2021.

Quality Incentive Pool (QIP) Program Year Three (PY3) Evaluation Report

On October 29, DHCS submitted the QIP PY3 Evaluation Report to CMS and posted it on the DHCS website. Beginning July 1, 2017, DHCS directed Medi-Cal MCPs to make performance-based quality incentive payments to 17 participating Designated Public Hospital (DPH) systems based on their performance on at least 20 quality measures that address primary, specialty, and inpatient care, including measures of appropriate resource utilization. To receive QIP payments, DPHs must achieve specified improvement targets. In PY3, the measurement per​iod and payment targets were modified with CMS' approval due to COVID-19. Hospitals could receive full payment if their performance exceeded a certain threshold, even if performance was worse than the prior year. The PY3 evaluation report provides comparisons between PY2 and PY3 for the quality of inpatient and outpatient services provided to Medi-Cal members at DPHs. DHCS found that all but one DPH (94 percent) met their payment target for all 20 measures, and there was aggregate improvement for more than half of the measures (61 percent).

Last modified date: 12/10/2021 4:22 PM