報告
管理式護理績效監控儀表板報告
The October release of the Managed Care Performance Monitoring Dashboard was published on the California Health & Human Services Agency Open Data Portal on November 1. The dashboard is a monitoring tool produced quarterly that includes comprehensive data on a variety of measures, such as enrollment, health care utilization, appeals and grievances, network adequacy, and quality of care. Information in the dashboard assists DHCS and its stakeholders with observing and understanding MCP performance statewide. The October release reports on monthly enrollment, demographics, and hearings totals from April 2020 to March 2021, monthly utilization totals from October 2019 to September 2020, and quarterly grievance totals from mid-2019 to early 2021.
質量激勵池（QIP）計劃第三年（PY3）評估報告
10 月 29 日，DHCS 向 CMS 提交了 QIP PY3 評估報告，並將其發佈在DHCS 網站上。從 7 月 11 日、22017 日開始，DHCS 指示 Medi-Cal MCP 根據 17 個參與的指定公立醫院 (DPH) 系統在至少 20 項品質指標上的表現，向其支付基於績效的品質激勵款項。這些品質指標涵蓋初級、專科和住院護理，包括適當的資源利用指標。要獲得品質改進計劃 (QIP) 付款，公共衛生部門必須達到規定的改善目標。在 PY3 中，由於 COVID-19 的影響，經 CMS 批准，對衡量週期和支付目標進行了修改。即使醫院的業績比前一年更差，但如果其業績超過一定標準，醫院也可以獲得全額付款。PY3 評估報告對 PY2 和 PY3 期間 DPH 為 Medi-Cal 會員提供的住院和門診服務品質進行了比較。DHCS 發現，除一個 DPH 外，其餘所有 DPH（94%）均達到了 20 項指標的支付目標，超過一半的指標（61%）總體上有所改善。