Quality Care Initiatives
改善 Medi-Cal 会员的健康状况
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.
会员心声
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.
会员顾问委员会 : 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.
提高质量透明度和问责制
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.
提高透明度：在过去三年中，DHCS 显著增加了有关交付系统和计划中质量和公平结果的公开报告数量，以提供更高的透明度并让合作伙伴能够使用数据来推动改进。 这包括但不限于：
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:
- 参与医疗保险和医疗补助服务中心 (CMS) 婴儿健康儿童访问学习协作项目。
- 为所有 MCP 创建新的区域协作，以讨论区域障碍、差异和潜在的社区伙伴。
- 主办 2023 年 DHCS 质量与健康公平会议，作为分享和交流质量与公平改进成功策略的论坛。
- 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.
推动质量和公平的财务激励
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.
投资社区
MCP 社区再投资：从 2024 年开始，所有盈利的 MCP 都必须将其利润的 7.5-15% 再投资于根据当地社区需求制定和指导的社区再投资活动。
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和行为健康转型计划通过向需要行为健康支持的个人提供协调的外展、导航和参与服务，增强了获得护理的机会。