Quality Care Initiatives
Txhim kho cov txiaj ntsig kev noj qab haus huv rau cov tswv cuab Medi-Cal
The California Department of Health Care Services (DHCS) is committed to achieving excellence in the quality and equity of care for Medi-Cal members. Through broader efforts focused on Medi-Cal Transformation, as well as through the ambitious 2022 Comprehensive Quality Strategy, DHCS outlined a Population Health Management approach grounded in high-quality primary care as well as the 50×2025 Bold Goals Initiative to improve health care outcomes for children’s preventive health, maternity care and birth equity, and behavioral health integration.
Centering Member Voices
Central to DHCS’ vision for quality and health equity is the belief that Medi-Cal members are at the center of our policy design and programs.
Health Equity Roadmap: The Health Equity Roadmap outlines DHCS’ plan to reduce health disparities by collecting data, identifying care gaps, and creating targeted interventions for high-risk groups. A statewide listening tour gathered member feedback directly from communities experiencing disparities to help shape this roadmap, which aims to build transparency and trust among diverse members.
Pawg Neeg Tawm Tswv Yim : In 2023, DHCS launched the Medi-Cal Member Advisory Committee (MMAC), a dedicated forum for Medi-Cal members to provide direct feedback to DHCS’ Director and executive leadership. The committee is composed entirely of Medi-Cal members and family caregivers, ensuring that a diverse range of perspectives is represented.
Txhim kho Transparency thiab Accountability rau Zoo
Quality Measurement in Behavioral Health: While DHCS has long tracked quality performance for Medi-Cal managed care plans (MCP), starting in 2022, DHCS also established a Behavioral Health Accountability Set (BHAS) to measure clinical quality outcomes in county Behavioral Health Plans.
Txhim Kho Transparency: Hauv peb lub xyoos dhau los, DHCS tau nce ntau qhov kev tshaj tawm rau pej xeem txog cov txiaj ntsig zoo thiab kev ncaj ncees thoob plaws cov txheej txheem xa khoom thiab cov phiaj xwm los muab kev txhim kho pob tshab thiab txhawb cov neeg koom tes siv cov ntaub ntawv los txhawb kev txhim kho. Qhov no suav nrog, tab sis tsis txwv rau:
- CalAIM Dashboard
- Daim Ntawv Qhia Txog Kev Tswj Xyuas Kev Kho Mob/Lub Zej Zog Zoo Tshaj Plaws Peb Hlis
- Managed Care Accountability Teem cov ntawv tseeb
- Tus Cwj Pwm Saib Xyuas Kev Noj Qab Haus Huv Kev Nyab Xeeb Teeb Cov Ntawv Qhia Tseeb
Sanctions and Accountability: MCPs failing to meet quality standards may face corrective action plans, financial penalties, or even contract termination in severe cases. Sanctions ensure plans prioritize quality care and improve service delivery where necessary. In the last three years, DHCS has strengthened its policy on quality sanctions for both MCPs and Behavioral Health Plans (BHP). Additionally, DHCS levied financial sanctions in 2022, 2023, and 2024 on MCPs that failed to meet DHCS’ target for quality outcomes (national 50th percentile).
Supporting Quality Improvement: DHCS partnered with MCPs on several quality improvement efforts to enhance the care of Medi-Cal members, including:
- Koom tes hauv Cov Chaw Pabcuam Medicare & Medicaid (CMS) Infant Well-Child Visit Learning Collaborative.
- Tsim kev sib koom tes hauv cheeb tsam tshiab rau txhua tus MCPs los tham txog cov teeb meem hauv cheeb tsam, qhov tsis sib xws, thiab cov neeg koom tes hauv zej zog.
- Kev tuav lub rooj sab laj DHCS Zoo & Kev Noj Qab Haus Huv Equity Conference hauv 2023 ua lub rooj sab laj rau cov phiaj xwm sib qhia thiab sib koom tes cov tswv yim ua tiav hauv kev txhim kho kom muaj txiaj ntsig zoo thiab kev ncaj ncees.
- Launching two new statewide learning collaboratives in 2024, one focused on improving and scaling children’s preventive services and the other focused on behavioral health integration and improved collaboration between MCPs and county behavioral health plans.
Kev txhawb nqa nyiaj txiag los txhawb kev ua tau zoo & kev ncaj ncees
Quality Withhold and Incentive Program: In 2024, DHCS implemented a Quality Withhold and Incentive (QWI) program. The program incentivizes MCPs to improve performance on quality metrics that align with the DHCS Comprehensive Quality Strategy and Bold Goals by withholding 0.5% of capitated payments, which can be earned back by meeting performance targets for quality, patient satisfaction, and efficiency.
Auto-Assignment Incentive Program: This program rewards higher performing MCPs in certain counties (with more than one MCP) with a greater percentage of new Medi-Cal members (who do not actively choose a MCP). In 2024, DHCS revised this long-standing Auto-Assignment Program to focus solely on MCP performance on select quality measures aligned with its Comprehensive Quality Strategy and Bold Goals.
Primary Care Spending and Alternative Payment Models: Starting in 2024, all MCPs are required to report to DHCS on what percentage of their spending is going toward primary care and how they are using alternative payment models with providers to reward quality and equity. DHCS worked with key state partners, including Covered California and CalPERS, to align these contract requirements across public purchasers.
Equity and Practice Transformation Payments: In 2024, DHCS launched the Equity and Practice Transformation Payment Program, a $140 million investment in primary care practices to advance health equity and reduce disparities by working on upstream care models, improving quality of care, value-based payment models, and practice transformation.
Kev nqis peev hauv zej zog
MCP Community Reinvestments: Pib xyoo 2024, txhua MCPs uas tau txais txiaj ntsig yuav tsum tau rov nqis peev 7.5-15% ntawm cov txiaj ntsig ntawd hauv zej zog kev nqis peev uas tau qhia thiab coj los ntawm cov zej zog xav tau.
California Advancing and Innovating Medi-Cal (CalAIM): CalAIM seeks to improve care for Medi-Cal members through Enhanced Care Management and Community Supports services, like housing navigation, medically tailored meals, and recovery housing, as alternatives to traditional medical services.
Behavioral Health Services: DHCS has significantly increased investments to expand telehealth, integrate behavioral health with primary care, and support the Behavioral Health Continuum Infrastructure Program (BHCIP) to build new treatment and community-based facilities.
- BH-CONNECT thiab cov kev pib hloov pauv kev noj qab haus huv ntawm tus cwj pwm tab tom txhim kho kev nkag mus rau kev saib xyuas los ntawm kev muab kev sib koom tes, kev taw qhia, thiab kev koom tes rau cov tib neeg uas xav tau kev txhawb nqa kev noj qab haus huv ntawm tus cwj pwm.