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.
Daim Ntawv Qhia Txog Kev Ncaj Ncees Hauv Kev Noj Qab Haus Huv: Daim Ntawv Qhia Txog Kev Ncaj Ncees Hauv Kev Noj Qab Haus Huv qhia txog DHCS txoj kev npaj los txo qhov sib txawv ntawm kev noj qab haus huv los ntawm kev sau cov ntaub ntawv, txheeb xyuas qhov sib txawv ntawm kev saib xyuas, thiab tsim cov kev cuam tshuam rau cov pab pawg muaj kev pheej hmoo siab. Ib qho kev ncig xyuas mloog thoob plaws lub xeev tau sau cov lus taw qhia ntawm cov tswv cuab ncaj qha los ntawm cov zej zog uas muaj kev tsis sib luag los pab tsim daim ntawv qhia kev npaj no, uas lub hom phiaj yog los tsim kom muaj kev pom tseeb thiab kev ntseeg siab ntawm cov tswv cuab sib txawv.
Pawg Neeg Tawm Tswv Yim Xyoo 2023, DHCS tau tsim Pawg Neeg Saib Xyuas Cov Tswv Cuab Medi-Cal (MMAC), uas yog lub rooj sib tham tshwj xeeb rau cov tswv cuab Medi-Cal los muab cov lus taw qhia ncaj qha rau Tus Thawj Coj thiab cov thawj coj ntawm DHCS. Pawg neeg no muaj cov tswv cuab ntawm Medi-Cal thiab cov neeg saib xyuas tsev neeg, kom ntseeg tau tias muaj ntau yam kev xav sib txawv.
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
Kev Pab Cuam Tiv Thaiv Kev Zoo thiab Kev Txhawb Nqa: Xyoo 2024, DHCS tau siv ib qho kev pab cuam Tiv Thaiv Kev Zoo thiab Kev Txhawb Nqa (QWI) . Qhov kev pab cuam no txhawb kom cov MCPs txhim kho kev ua tau zoo ntawm cov ntsuas zoo uas sib haum nrog DHCS Comprehensive Quality Strategy thiab Bold Goals los ntawm kev txiav 0.5% ntawm cov nyiaj them rau txhua tus neeg, uas tuaj yeem khwv tau rov qab los ntawm kev ua tiav cov hom phiaj kev ua tau zoo rau qhov zoo, kev txaus siab ntawm tus neeg mob, thiab kev ua haujlwm tau zoo.
Kev Pab Txhawb Nqa Kev Muab Kev Pabcuam Tsis Siv Neeg: Qhov kev pab cuam no muab nqi zog rau cov MCP uas ua tau zoo dua hauv qee lub nroog (uas muaj ntau dua ib lub MCP) nrog rau feem pua ntawm cov tswv cuab Medi-Cal tshiab (uas tsis xaiv MCP). Xyoo 2024, DHCS tau kho dua qhov Kev Pabcuam Ua Haujlwm Tsis Siv Neeg no kom tsom mus rau kev ua tau zoo ntawm MCP ntawm cov kev ntsuas zoo xaiv uas phim nrog nws Txoj Kev Npaj Zoo thiab Cov Hom Phiaj Loj.
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 Kev Txhim Kho thiab Kev Tsim Kho Medi-Cal (CalAIM): CalAIM nrhiav kev txhim kho kev saib xyuas rau cov tswv cuab Medi-Cal los ntawm Kev Tswj Xyuas Kev Saib Xyuas Zoo Dua thiab Kev Txhawb Nqa Hauv Zej Zog , xws li kev nrhiav chaw nyob, kev noj mov kho mob uas tsim tshwj xeeb, thiab chaw nyob rau kev kho mob, ua lwm txoj hauv kev rau cov kev pab kho mob ib txwm muaj.
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.