Researchers Call for Quality-Improvement Changes in Medi-Cal Plans []


By Xenia Shih Bion, California Health Care Foundation, October 7, 2019

California should move swiftly to improve the quality of care in the managed care plans that serve 80% of Medi-Cal’s nearly 14 million enrollees, according to researchers at the University of California, San Francisco (UCSF). Led by Professor of Medicine Andrew Bindman, MD, with support from CHCF, the researchers examined 41 quality measures and found that more than half of the quality measures stayed the same or declined from 2009 to 2018. The metrics included rates of cancer screenings, timely pre- and postnatal care for women, and access to primary care for children.

With so many Medi-Cal enrollees in managed care plans, the lagging quality improvement suggests there is a great opportunity to improve care for California children, their parents and caretakers, persons with disabilities, and adults typically in low-wage jobs. The California Department of Health Care Services (DHCS) administers Medi-Cal. The findings have excited Medicaid experts around the country.

Andy Schneider, a research professor at the Georgetown University McCourt School of Public Policy, said the report represents “an important step forward on the road to full transparency about Medicaid managed care.” In a blog post for the Georgetown University Center for Children and Families, Schneider said it was not clear before the report was released whether the Center for Medicare & Medicaid Services (CMS) knew about the unsatisfactory quality scores across Medi-Cal managed care plans. “Now everyone knows,” he wrote, “and the process of holding the [managed care plans], the state Medicaid agency, and CMS accountable for results can begin.”

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