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
Qhov tseem ceeb rau DHCS lub zeem muag rau qhov zoo thiab kev ncaj ncees ntawm kev noj qab haus huv yog kev ntseeg tias cov tswv cuab Medi-Cal yog lub hauv paus ntawm peb txoj cai tsim thiab cov kev pab cuam.
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
Kev Ntsuas Zoo Hauv Kev Noj Qab Haus Huv Tus Cwj Pwm: Txawm hais tias DHCS tau taug qab kev ua tau zoo rau Medi-Cal cov phiaj xwm kev saib xyuas (MCP), pib xyoo 2022, DHCS kuj tau tsim tsa Pawg Neeg Saib Xyuas Kev Noj Qab Haus Huv Tus Cwj Pwm (BHAS) los ntsuas cov txiaj ntsig zoo hauv kev kho mob hauv cov phiaj xwm kev noj qab haus huv tus cwj pwm hauv nroog.
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
Kev Rau Txim thiab Kev Lav Ris: Cov MCPs uas ua tsis tau raws li cov qauv zoo yuav ntsib cov phiaj xwm kho, kev nplua nyiaj txiag, lossis txawm tias kev txiav daim ntawv cog lus hauv cov xwm txheej hnyav. Kev rau txim ua kom cov phiaj xwm muab qhov tseem ceeb rau kev saib xyuas zoo thiab txhim kho kev muab kev pabcuam yog tias tsim nyog. Nyob rau peb xyoos dhau los no, DHCS tau txhawb nws txoj cai tswjfwm txog kev rau txim rau cov MCPs thiab Behavioral Health Plans (BHP). Tsis tas ntawd xwb, DHCS tau nplua nyiaj txiag rau xyoo 2022, 2023, thiab 2024 rau MCPs uas ua tsis tau raws li DHCS lub hom phiaj rau cov txiaj ntsig zoo (lub teb chaws 50 feem pua .
Txhawb Kev Txhim Kho Zoo: DHCS tau koom tes nrog MCPs rau ntau yam kev siv zog txhim kho zoo los txhim kho kev saib xyuas cov tswv cuab Medi-Cal, suav nrog:
- 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.
- Xyoo 2024, lawv tau pib ob txoj kev koom tes kawm tshiab thoob plaws lub xeev, ib qho yog tsom mus rau kev txhim kho thiab nthuav dav cov kev pabcuam tiv thaiv menyuam yaus thiab lwm qhov yog tsom mus rau kev koom ua ke ntawm kev noj qab haus huv tus cwj pwm thiab kev txhim kho kev koom tes ntawm MCPs thiab cov phiaj xwm kev noj qab haus huv tus cwj pwm hauv nroog.
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.
Kev Siv Nyiaj Rau Kev Kho Mob Thawj Zaug Thiab Cov Qauv Them Nyiaj Lwm Txoj: Pib xyoo 2024, txhua tus MCP yuav tsum tshaj tawm rau DHCS txog feem pua ntawm lawv cov nyiaj siv rau kev kho mob thawj zaug thiab lawv siv cov qauv them nyiaj lwm txoj li cas nrog cov neeg muab kev pabcuam los muab nqi zog rau qhov zoo thiab kev sib luag. DHCS tau ua haujlwm nrog cov neeg koom tes tseem ceeb hauv xeev, suav nrog Covered California thiab CalPERS, los ua kom cov kev cai ntawm daim ntawv cog lus no sib haum rau cov neeg yuav khoom pej xeem.
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.
Kev Pabcuam Kev Noj Qab Haus Huv: DHCS tau nce kev nqis peev ntau heev los nthuav dav kev kho mob hauv xov tooj, kev koom ua ke kev noj qab haus huv nrog kev kho mob thawj zaug, thiab txhawb nqa Kev Pabcuam Kev Noj Qab Haus Huv Txuas Ntxiv Mus Rau Kev Kho Mob (BHCIP) los tsim cov chaw kho mob tshiab thiab cov chaw hauv zej zog.
- 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.