Category: Outcomes

The California Department of Health Care Services contracts with an external quality review organization to evaluate the care provided to Medi-Cal managed care beneficiaries in the areas of quality, access, and timeliness. Reports are available on the DHCS website, including member satisfaction surveys, encounter data validation study reports, managed care accountability sets, external quality review technical reports, plan-specific evaluation reports, health disparity reports, HEDIS® reports, MCP-specific performance evaluation reports, performance improvement project reports, and preventive services reports.

Outline

• Introduction: Purpose of the DHCS external quality review organization
• Available Reports:
  • Member Satisfaction Surveys
  • Encounter Data Validation Study Reports
  • Managed Care Accountability Sets/External Accountability Sets
  • External Quality Review Technical Reports and Plan-Specific Evaluation Reports
  • Health Disparity Reports
  • HEDIS® Reports
  • MCP-Specific Performance Evaluation Reports
  • Performance Improvement Project Reports
  • Preventive Services Report
• Conclusion: Summary of available reports and their purpose.

In accordance with federal requirements, the California Department of Health Care Services (DHCS) contracts with an external quality review organization (EQRO) to conduct external quality reviews and evaluate the care provided to beneficiaries by Medi-Cal managed care health plans (MCPs) in the areas of quality, access, and timeliness. The EQRO presents these external quality review activities, results, and assessments in reports that help DHCS and Medi-Cal MCPs understand where to focus resources to further improve the quality of care.

Medi-Cal Managed Care Quality Strategy Reports

The Medi-Cal Managed Care Quality Strategy Reports are DHCS’ written strategy for assessing and improving the quality of managed care services offered by all Medi-Cal MCPs.

Member Satisfaction Surveys (CAHPS® Surveys)

Each Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey report aggregates the results of CAHPS® surveys, which ask Medi-Cal managed care beneficiaries to evaluate their experiences with their health care health care providers.

Encounter Data Validation Study Reports

Encounter Data Validation (EDV) Study Reports examine the completeness and accuracy of the encounter data submitted to DHCS by the MCPs.

Managed Care Accountability Sets / External Accountability Sets

The Managed Care Accountability Sets (MCAS) / External Accountability Set (EAS) is a set of performance measures that DHCS selects for annual reporting by Medi-Cal MCPs.

External Quality Review Technical Reports and Plan-Specific Evaluation Reports

The EQRO annually prepares an independent external quality review technical report that analyzes and evaluates aggregated information on the health care services provided by Medi-Cal MCPs. As part of the external quality review technical report, the EQRO prepares a plan-specific evaluation report of each of MCP.

Access these reports on the Medi-Cal Managed Care External Quality Review Technical Reports with Plan-Specific Evaluation Reports.

Health Disparity Reports

The Health Disparity Reports identify and understand health disparities affecting California’s Medi-Cal managed care members and are based on focused studies conducted annually by the EQRO. The reports analyze Managed Care Accountability Set (MCAS) measure results reported by Medi-Cal managed care plans (MCPs) for various demographic categories.

HEDIS® Reports

The Healthcare Effectiveness Data and Information Set (HEDIS®) Aggregate Report, also referred to as Performance Measurement Reports, provides performance rates of MCPs during a reporting year and trending using previous years’ data. The report also compares plan-specific and aggregated rates to national benchmarks.

MCP-Specific Performance Evaluation Reports

The MCP-Specific Performance Evaluation Reports are also referred to as Plan-Specific Performance Evaluation Reports.

Access these reports on the Medi-Cal Managed Care Quality Improvement Reports webpage

Performance Measures and HEDIS® Reports

Access Medi-Cal Managed Care’s annual performance measure, External Accountability Set, on the Medi-Cal Managed Care Quality Improvement Reports webpage.

The following performance measure results are also available on our website:

• Access HEDIS® report for results of reporting years (RYs) 1999 through 2015 on the Medi-Cal Manage Care Improvement Reports webpage: HEDIS® Reports webpage
• Access External Quality Review Technical Reports for results after RY 2015, performance measure results, including HEDIS® measures on the Medi-Cal Managed Care Improvement Reports: External Quality Review Technical Reports with Plan-Specific Evaluation Reports webpage
• Access HIV Viral Suppression Rates by Medi-Cal Managed Care Plan, 2015-2017 on the Medi-Cal Managed Care Improvement Reports webpage: HEDIS® Reports Webpage

Performance Improvement Project Reports

• Plan-specific results and aggregated PIP results are reported annually in the External Quality Review Technical Reports and Plan-Specific Evaluation Reports. Access those reports on the Medi-Cal Managed Care Quality Improvement Reports: External Quality Review Technical Reports with Plan-Specific Evaluations Reports webpage.
• Access quarterly QIP reports 2008 through June 2015 on the Medi-Cal Managed Care Quality Improvement Reports: Quality Improvement Project Reports

Plan-Specific Performance Evaluation Reports

Plan-Specific Performance Evaluation Reports are also referred to as MCP-Specific Performance Evaluation Reports.

Access the reports on the  Medi-Cal Managed Care Quality Improvement Reports: External Quality Review Technical Reports and Plan-Specific Evaluation Reports.

Quality Improvement Project Reports

Quality Improvement Project (QIP) Reports are available on the Medi-Cal Managed Care Quality Improvement Reports: Quality Improvement Project Reports webpage.

Technical Reports

Technical Reports are available on the Medi-Cal Managed Care Quality Improvement Reports: External Quality Review Technical Reports webpage.

Preventive Services Report

The 2021 Preventive Services Report and Executive Summary assist with identifying and monitoring appropriate utilization of preventive services for children in Medi-Cal Managed Care.

The 2020 Preventive Services Report and Addendum assesses the provision of preventive services by pediatric Medi-Cal managed care members.