Quality Care Initiatives
메디칼 가입자를 위한 건강 결과 개선
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.
회원의 목소리 중심
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.
회원 자문 위원회 : 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.
품질에 대한 투명성 및 책임성 향상
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.
투명성 개선: 지난 3년 동안 DHCS는 전달 시스템 및 이니셔티브 전반의 품질 및 형평성 결과에 대한 공개 보고를 대폭 늘려 투명성을 개선하고 파트너가 데이터를 사용하여 개선을 추진할 수 있도록 역량을 강화했습니다. 여기에는 다음이 포함되지만 이에 국한되지는 않습니다:
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:
- 메디케어 센터 & 메디케이드 서비스(CMS) 유아 웰-차일드 방문 학습 협력에 참여합니다.
- 모든 MCP가 지역 장벽, 격차, 잠재적 커뮤니티 파트너에 대해 논의할 수 있는 새로운 지역 협력체를 구축합니다.
- 2023년에 품질 및 형평성 개선의 성공적인 전략을 공유하고 네트워크를 구축하기 위한 포럼으로 DHCS 품질 & 건강 형평성 컨퍼런스를 개최합니다.
- 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.
품질 향상을 위한 재정적 인센티브 & 형평성
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.
커뮤니티에 대한 투자
MCP 커뮤니티 재투자: 2024년부터 수익을 창출하는 모든 MCP는 해당 수익의 7.5-15%를 지역 사회의 필요에 따라 정보를 제공하고 안내하는 지역 사회 재투자 활동에 재투자해야 합니다.
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 및 행동 건강 혁신 이니셔티브는 행동 건강 지원이 필요한 개인에게 조정된 아웃리치, 탐색 및 참여 서비스를 제공하여 치료 접근성을 향상시키고 있습니다.