Medi-Cal Quality Improvement Projects

Health Net conducts a minimum of two quality improvement projects (QIPs) annually in its ongoing effort to improve health outcomes of Medi-Cal members. QIPs target specific health issues that are a concern or problem for a significant number of members. They also target under-utilized health services for which intervention may potentially increase utilization and significantly enhance health outcomes.

QIPs are developed by the Health Net quality Improvement division in collaboration with Health Net's Medi-Cal medical directors. QIPs, which may be ongoing programs or one-time interventions, target both members and providers and address cultural and linguistic issues relevant to Health Net's membership.

Each QIP is assigned a specific criteria set to measure the success of the intervention. Re-measurement is conducted annually for a minimum of two years, and the data is analyzed to determine the statistical impact of the intervention. Results of all QIPs are reported to the Department of Health Care Services (DHCS), Health Net Community Solutions Utilization Management and Quality Improvement (HNCS UM/QI), Health Services Advisory Group (HSAG) - an External Quality Review Organization (EQRO), Health Net senior management, Health Net medical directors, and the Health Net board of directors.

The development process for each QIP entails the following:

1. Initial barrier analysis.
2. Collection of baseline data for the QIP.
3. Development of member and provider interventions.
4. Implementation of interventions.
5. First remeasurement one year after implementation.
6. Analysis of first remeasurement data.
7. Additional barrier analysis, if necessary.
8. Implementation of subsequent interventions.
9. Second remeasurement one year after the first remeasurement.
10. Analysis of the second remeasurement data.
11. Final report submission to DHCS for approval of QIP closure.

Contact the QI Department for more information on current QIPs.