加州要求 Medi-Cal 计划负责确保会员获得高质量、公平的医疗服务
新闻稿
加州要求 Medi-Cal 计划负责确保会员获得高质量、公平的医疗服务
SACRAMENTO — The Department of Health Care Services (DHCS) today published quality ratings for Medi-Cal managed care plans (MCP) and county behavioral health plans (BHP). DHCS oversees all MCPs to ensure the plans provide members with the best possible care and to increase transparency.
Monetary sanctions are being imposed on MCPs that did not meet or exceed the established minimum performance levels (MPL), meaning the plans failed to provide members with a level of care that reached the quality standards established by DHCS. Today’s actions are the result of the MCP contract, effective January 1, 2024, which significantly strengthened quality and health equity requirements for MCPs.
“加州致力于通过让计划合作伙伴对既定基准负责并推动可衡量的改进来提高医疗保健质量，” DHCS 主任 Michelle Baass说。“通过加强问责制、促进健康公平、加强协作以及与各计划合作，我们正在提升医疗服务水平，改善所有 Medi-Cal 会员的健康结果。通过这些共同努力，DHCS 旨在支持 Medi-Cal 管理式医疗计划、县级行为健康计划和医疗服务提供者，为所有 Medi-Cal 会员提供更好的健康结果。
WHY THIS IS IMPORTANT: The quality ratings are part of DHCS’ Bold Goals 50×2025 initiative, which targets improvements in children’s health, reproductive care, cancer prevention, maternal health, and behavioral health integration. By releasing these ratings, DHCS encourages MCPs and BHPs to provide improved care, particularly in areas like preventive and primary care services as well as behavioral health services.
WHAT THIS MEANS FOR CALIFORNIANS: Based on the quality ratings, MCPs will take corrective actions, including providing more proactive care to members, such as supporting them in finding a primary care provider and scheduling well-child visits, helping with transportation needs to appointments and picking up prescriptions, assisting them with accessing programs like CalFresh, and screening for eligibility for Enhanced Care Management and Community Supports. MCPs will also ensure their network providers increase evening and weekend appointments and reduce wait times to improve access to care. Additionally, BHPs will focus on improving access to timely and culturally responsive behavioral health services. This includes reaching out to members to connect them with therapy and counseling and supporting them in managing serious mental health conditions and substance use disorders (SUD).
新的制裁措施：在与DHCS签订合同的24家医疗管理服务提供商中，有20家（83.3%）因未达到管理式医疗责任制（MCAS）质量指标中合同要求的最低医疗绩效指标（MPL）而受到制裁，比2022年衡量年度（MY）的情况还要严重。制裁金额从 25,000 美元到 819,000 美元不等，总计 3,069,000 美元，低于 2022 财年。
MCAS 制裁是根据受影响人数、MCP 绩效变化以及 MCP 健康场所指数得分等因素确定的。今年制裁的主要原因是儿童局部氟化物（TFL-CH）、儿童和青少年健康检查以及宫颈癌筛查，由于这些措施对大量人口产生影响，因此它们加起来约占制裁总数的 82%。超过 150 万名会员未获得 TFL-CH 服务，导致约 110 万美元的罚款。医疗护理专业人员 (MCP) 应积极参与改进工作，例如会员和社区参与，以及改善医疗、牙科和行为健康等服务体系之间的健康信息共享，以改善会员获得和使用所有所需健康服务的机会。
除了对 MCP 进行质量评级外，DHCS 还发布了第二年的 BHP 行为健康责任制 (BHAS) 质量评分。对于县级 BHP 而言，71% 的县在至少一半的心理健康指标上达到或超过了基准。各县在药物滥用指标方面的表现类似，80% 的县在至少一半的药物滥用指标上达到或超过了基准。虽然今年没有对必和必拓公司处以罚款，但执法行动将在未来几年开始。DHCS致力于创建一个透明的系统，拥有可靠的数据，并建立长期的问责机制，以提供更好的行为健康护理。
如需更详细地了解绩效指标，请参阅以下内容：
质量改进： DHCS 致力于支持 MCP 通过设定明确的目标、提供及时的数据以及与社区合作来提高预防性服务的可及性，从而改善其绩效。DHCS 分享最佳实践，提供技术援助，并创建区域合作组织，让 MCP 可以讨论挑战和潜在的解决方案。2024 年，DHCS 启动了两项新的全州合作计划，重点关注儿童预防服务和行为健康整合。
Additionally, DHCS has engaged with BHPs on quality improvement through regular Behavioral Health Regional Collaborative meetings to share best practices and quality improvement strategies. Further, DHCS has partnered with the Institute for Healthcare Improvement (IHI) on a Behavioral Health Demonstration Collaborative designed to enable whole-person care that seamlessly addresses the behavioral, physical, and health-related social needs of Medi-Cal members. Read the Quality Fact Sheet to learn more about how DHCS is working to improve quality of care for members.
ADDITIONAL INFORMATION: DHCS’ Comprehensive Quality Strategy focuses on improving health outcomes through the Bold Goals 50X2025 initiative. Since 2022, DHCS has been publicly releasing annual quality measure ratings for all MCPs and requiring quality improvement actions. Since 2023, DHCS has publicly released annual quality measure ratings for all BHPs and will begin requiring quality improvement actions. These efforts, as well as targeted audits of MCPs and BHPs and enhanced quality improvement and oversight, are aimed at improving health outcomes for millions of Californians. Assembly Bill 1642 (Chapter 465, Statutes of 2019) authorized DHCS to increase sanctions for MCPs that do not meet or exceed required MPLs. The MCP contracts, which became effective on January 1, 2024, promotes a more person-centered, equity-focused, and data-driven Medi-Cal program.
Additionally, in the behavioral health field, the Drug Medi-Cal Organized Delivery System Interagency Agreements and mental health plan contracts require BHPs to establish Quality Improvement Systems and to collect and submit performance measurement data required by DHCS, according to the Comprehensive Quality Strategy. DHCS also released Behavioral Health Information Notice 24-004 in December 2023 to clarify DHCS requirements for the BHPs’ Quality Improvement Systems. DHCS will launch the Behavioral Health Quality Improvement and Health Equity Framework in 2025, which will focus on improving BHAS measure performances.
###