20-982m Stay Informed on Quality Goals and Activities to Improve the Health of Members
Date: 11/30/20
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.
Check out the progress made and improvements still needed from 2020 MCAS and HEDIS® quality performance results
The Quality Improvement Program monitors performance of clinical care and service measures using many internal and external health care data collection systems. The Managed Care Accountability Set (MCAS) reflects the quality measures health plans and their providers need to meet each year.
The tables indicate whether clinical care and service measures improved or declined from Reporting Year 2019 to Reporting Year 2020 using Healthcare Effectiveness Data and Information Set (HEDIS®) measures, MCAS and the satisfaction survey. The national benchmarks from year to year allow us to compare our results and identify areas of improvement to close care gaps. Care gaps are the number of members who need to complete a service to meet the national benchmarks.
Results for Medi-Cal plans are compared to the Department of Health Care Services (DHCS) Minimum Performance Level (MPL) and the National Committee for Quality Assurance (NCQA) Quality Compass® national HMO 75th percentile. As a participating provider and by meeting these goals, you play a vital role in helping our members stay healthy.
Quality Improvement support for members and providers to improve health outcomes
Health Net, on behalf of CalViva Health, launched a series of live calls to address many gaps in care in 2020. This outreach targets members that are noncompliant with their prescribed medications for these measures:
- Asthma Medication Ratio (AMR)
- Comprehensives Diabetes Care (CDC)
- Controlling Blood Pressure (CBP)
- Hemoglobin A1c (HBA1c) Poor Control
These ongoing programs support you and our members to help make access to care easier:
Program | Description |
|---|---|
Mobile mammogram events | Hosted in Fresno County to address location and appointment availability barriers for breast cancer screenings. |
Extend clinic hours through One Stop Clinics | Helped address member care needs for those facing access to care barriers (beyond regular business hours). |
Behavioral health outreach | Help members process uncertainty, maintain connection while social distancing, and keep a positive perspective during the COVID-19 crisis.
|
Support for parents and guardians during COVID-19 pandemic | Live outreach to offer assistance around scheduling a doctor visit and linking members to community resources. |
Flu shots | Carried out the multimodal campaign (mail, email, proactive outreach manager) to urge members to get their flu shot and partnered with a vendor to provide in-home flu shots. |
Tables to compare performance goals
The following tables indicate whether clinical care and service measures improved or declined from Reporting Year 2019 to Reporting Year 2020 using MCAS, HEDIS® measures and the satisfaction survey. It also shows how our performance compares to national benchmarks. While we have made improvements over the prior year, many measures remain above the 75th percentile goal.
HEDIS/MCAS measures of clinical care | RY2019
|
RY2020
| Rates compared to previous year | 2020 DHCS MPL | 2020 score compared to DHCS MPL |
|---|---|---|---|---|---|
Adult body mass index (BMI) assessment | - | 90.75% | - | 90.27% | ↑ |
Antidepressant medication management – acute phase | - | 48.20% | - | 52.33% | ↓ |
Antidepressant medication management – continuation phase | - | 31.84% | - | 36.51% | ↓ |
Asthma Medication Ratio | 63.32% | 64.16% | ↑ | 63.58 % | ↑ |
Breast cancer screening | 51.12% | 55.26% | ↑ | 58.67% | ↓ |
Cervical cancer screening | 59.57% | 63.50% | ↑ | 60.65% | ↑ |
Childhood immunization – Combo 10 | - | 33.82% | - | 34.79% | ↓ |
Chlamydia screening in women | - | 61.26% | - | 58.34% | ↑ |
Comprehensive diabetes care: hemoglobin A1c testing | 84.43% | 87.83% | ↑ | 88.55% | ↓ |
Comprehensive diabetes care: HbA1c poor control > 9% | 41.61% | 34.06% | ↓ | 38.52% (inverted rate) | ↑ |
Controlling high blood pressure | 60.34% | 62.03% | ↑ | 61.04% | ↑ |
Immunizations for adolescents – combination 2 | 38.69% | 38.69% | - | 34.43% | ↑ |
Timeliness of prenatal care | 85.56% | 92.21% | ↑ | 83.76% | ↑ |
Postpartum care | 70.83% | 78.83% | ↑ | 65.69% | ↑ |
Weigh assessment and counseling for nutrition and physical activity for children/adolescents: BMI assessment | - | 82.73% | - | 79.09%. | ↑ |
Well-child visits in the first 15 months of life: six or more well-child visits | - | 56.45% | - | 65.83% | ↓ |
Well-child visits in 3rd, 4th, 5th and 6th years of life | 71.15% | 74.85% | ↑ | 72.87% | ↑ |
Measures of service** | RY2019 score | RY2020 score | Compared to previous year | 2020 Quality Compass National HMO 75th percentile | 2020 score compared to 75th percentile |
|---|---|---|---|---|---|
Customer service | 85.73% | - | - | 91.0% | - |
Getting care quickly | 75.34% | 73.31% | ↑ | 85.1% | ↓ |
How well doctors communicate | 88.04% | 86.52% | ↓ | 93.4% | ↓ |
*Admin rates reported.
**Health Service Advisory Group, Inc. CAHPS survey results.
HEDIS/MCAS measures of clinical care | RY2019
|
RY2020
| Rates compared to previous year | 2020 DHCS MPL | 2020 score compared to DHCS MPL |
|---|---|---|---|---|---|
Adult body mass index (BMI) assessment | - | 94.65% | - | 90.27% | ↑ |
Antidepressant medication management – acute phase | - | 47.74% | - | 52.33% | ↓ |
Antidepressant medication management – continuation phase | - | 27.44% | - | 36.51% | ↓ |
Asthma Medication Ratio | 66.82% | 69.75% | ↑ | 63.58 % | ↑ |
Breast cancer screening | 58.05% | 62.44% | ↑ | 58.67% | ↑ |
Cervical cancer screening | 63.40% | 65.21% | ↑ | 60.65% | ↑ |
Childhood immunization – Combo 10 | - | 46.96% | - | 34.79% | ↑ |
Chlamydia screening in women | - | 55.42% | - | 58.34% | ↓ |
Comprehensive diabetes care: hemoglobin A1c testing | 89.68% | 93.43% | ↑ | 88.55% | ↑ |
Comprehensive diabetes care: HbA1c poor control > 9% | 40.29% | 36.25% | ↑ | 38.52% (inverted rate) | ↑ |
Controlling high blood pressure | 69.10% | 69.77% | ↑ | 61.04% | ↑ |
Immunizations for adolescents – combination 2 | 53.55% | 54.88% | ↑ | 34.43% | ↑ |
Timeliness of prenatal care | 85.94% | 91.48% | ↑ | 83.76% | ↑ |
Postpartum care | 63.54% | 81.51% | ↑ | 65.69% | ↑ |
Weigh assessment and counseling for nutrition and physical activity for children/adolescents: BMI assessment | - | 95.38% | - | 79.09%. | ↑ |
Well-child visits in the first 15 months of life: six or more well-child visits | - | 70.07% | - | 65.83% | ↑ |
Well-child visits in 3rd, 4th, 5th and 6th years of life | 83.57% | 83.57% | - | 72.87% | ↑ |
Measures of service** | RY2019 score | RY2020 score | Compared to previous year | 2020 Quality Compass National HMO 75th percentile | 2020 score compared to 75th percentile |
|---|---|---|---|---|---|
Customer service | 85.73% | - | - | 91.0% | - |
Getting care quickly | 75.34% | 73.31% | ↑ | 85.1% | ↓ |
How well doctors communicate | 88.04% | 86.52% | ↓ | 93.4% | ↓ |
*Admin rates reported.
**Health Service Advisory Group, Inc. CAHPS survey results.
HEDIS/MCAS measures of clinical care | RY2019
| RY2020
| Rates compared to previous year | 2020 DHCS MPL | 2020 score compared to DHCS MPL |
|---|---|---|---|---|---|
Adult body mass index (BMI) assessment | - | 95.13% | - | 90.27% | ↑ |
Antidepressant medication management – acute phase | - | 43.72% | - | 52.33% | ↓ |
Antidepressant medication management – continuation phase | - | 29.55% | - | 36.51% | ↓ |
Asthma Medication Ratio | 66.58% | 71.17% | ↑ | 63.58 % | ↑ |
Breast cancer screening | 56.21% | 57.30% | ↑ | 58.67% | ↓ |
Cervical cancer screening | 66.49% | 70.07% | ↑ | 60.65% | ↑ |
Childhood immunization – Combo 10 | - | 33.09% | - | 34.79% | ↓ |
Chlamydia screening in women | - | 64.48% | - | 58.34% | ↑ |
Comprehensive diabetes care: hemoglobin A1c testing | 91.24% | 91.24 % | - | 88.55% | ↑ |
Comprehensive diabetes care: HbA1c poor control > 9% | 35.77% | 35.77% | - | 38.52% (inverted rate) | ↑ |
Controlling high blood pressure | 62.29% | 64.43% | ↑ | 61.04% | ↑ |
Immunizations for adolescents – combination 2 | 30.41% | 35.04% | ↑ | 34.43% | ↑ |
Timeliness of prenatal care | 87.19% | 95.38% | ↑ | 83.76% | ↑ |
Postpartum care | 60.80% | 86.13% | ↑ | 65.69% | ↑ |
Weigh assessment and counseling for nutrition and physical activity for children/adolescents: BMI assessment | - | 91.73% | - | 79.09%. | ↑ |
Well-child visits in the first 15 months of life: six or more well-child visits | - | 62.53% | - | 65.83% | ↓ |
Well-child visits in 3rd, 4th, 5th and 6th years of life | 73.68% | 73.68% | - | 72.87% | ↑ |
Measures of service** | RY2019 score | RY2020 score | Compared to previous year | 2020 Quality Compass National HMO 75th percentile | 2020 score compared to 75th percentile |
|---|---|---|---|---|---|
Customer service | 85.73% | - | - | 91.0% | - |
Getting care quickly | 75.34% | 73.31% | ↑ | 85.1% | ↓ |
How well doctors communicate | 88.04% | 86.52% | ↓ | 93.4% | ↓ |
*Admin rates reported.
**Health Service Advisory Group, Inc. CAHPS survey results.
Additional information
If you have questions regarding the information contained above, contact CalViva Health at 1-888-893-1569.