New study shows slow moving improvement in California Managed Care program

A new report from the California Health Care Foundation (CHCF) and the Philip R. Lee Institute for Health Policy Studies at UCSF shows lagging quality in Medi-Cal Managed Care. 

The report looks at the quality of care provided by Medi-Cal managed care plans (MCPs) between 2009 and 2018. Authors of the report looked at the care provided under different MCP ownership: public, non-profit, and for-profit. 41 different quality measures were assessed in order to track the rate of cancer screenings, timely pre- and postnatal care for women, access to primary care for children, and patients’ rating of their health plan, among many other elements of care and the patient experience.

 

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The report finds that during the nine year time period, most of the quality measures showed very little movement in either direction. Specifically, 59% of the 41 quality measures analyzed saw no change, or a slight decline. Overall there was no improvement in the Medi-Cal care over these years — in fact, in 4 of the categories, care declined. 

Six of the 9 quality measures currently in use that are related to children declined or stayed the same. The other three measures showed that there was improvement in only 3 of these measures.

The quality of care also varied based on MCP ownership. The for-profit scores were substantially lower on average, relative to the nonprofit and public MCPs. 

Following the release of the results in the report, Chris Perrone, Director of Improving Access at CHCF, published a post with suggestions for California policymakers to improve quality care measures. 

“Particularly disappointing was the fact that quality declined or stayed the same for six of the nine measures related to care for children, including access to primary care and well-child visits. Simply put, we just haven’t seen the type of quality improvement over the last decade that we would expect from a program as important to our state as Medi-Cal,” Perrone stated in response to the data. 

Perrone outlined five key actions that California can take to improve care quality: 

1. Establish clear, measurable quality goals for the Medi-Cal managed care program and for individual plans, with a focus on continuous improvement.

Chris suggests that though the Department of Health Care Services recently stated it was raising performance expectations, this is not enough. He suggests that quality measures should continually increase even when they are performing above the 50th percentile. 

2. Pay plans based on quality.

“Governor Gavin Newsom has shown he understands how important it is to pay health care providers based on quality and outcomes, not just on the volume of services they provide. It’s time to extend this principle to the way California pays Medi-Cal managed care plans and use financial incentives to drive quality improvement,” Peronne explains. 

3. Eliminate data blind spots related to disparities and delegation.

Peronne suggests that you cannot improve upon data that you do not have. Quality of care varies widely by socio-economic status, and thus data should be collected to better improve upon these areas. 

4. Consider restructuring the Medi-Cal managed care system.

The data, Peronne states, suggests that a different approach to Medi-Cal should be considered. If improvement is not steady, he says, it may be time to consider a different model.  

5. Continue to invest in delivery system transformation and in the health care workforce, especially in rural areas.

“Recognizing that this will be a decades-long effort requiring political will and resources, the state must launch long-term investments and partnerships to build the health care workforce, especially in rural areas. The 2019–20 state budget, which provides hundreds of millions of dollars in state funding to ease mental health workforce shortages and low rates of physician participation in Medi-Cal, was a significant first step,” Peronne proposes. 

While the quality of care overall remained stagnant, and even declined in some areas, there were a number of success stories in the managed care space. Another California Health Care Foundation report showed that areas like targeted financial incentives, leadership commitment, real-time data exchange, and provider collaboration are being actively worked on. 

And, individual providers had success stories as well. CalViva Health, for example, used “data analysis as well as training and education of staff at a few high-volume, low-performing clinics to improve blood pressure control among diabetic patients, which rose from 53% in 2013 to 68% in 2018.”

“State officials should act swiftly to ensure that all enrollees, regardless of where they live or which plan they are enrolled in, have timely access to high-quality care. Some of these actions can be taken immediately. Others could be pursued as part of a bold new vision that guides both the upcoming planning process for the renewal of two federal Medicaid waivers, as well as the contract renewal process for commercial Medi-Cal managed care plans that begins next year,” Peronne recommends for action moving forward.