24-171m Stay Informed About Quality Goals and Activities to Improve Members' Health

Date: 02/20/24

See the progress made and improvements still needed based on 2023 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. Managed Care Accountability Set (MCAS) reflect the quality measures health plans and their providers need to meet each year.

Results for Medi-Cal plans are compared to the Department of Health Care Services (DHCS) 50th percentile Minimum Performance Level (MPL) for MCAS measures, and the National Committee for Quality Assurance (NCQA) Quality Compass national HMO 50th percentile, if applicable. As a participating provider, you play a vital role in helping our members stay healthy.

Quality Improvement supports the enhancement of member experience through Quality Improvement initiatives

In 2022, Health Net, on behalf of CalViva Health, initiated a series of live calls to address care gaps. These calls were outreached to members noncompliant with their prescribed medications for the following measures:

• Asthma Medication Ratio (AMR).
• Comprehensives Diabetes Care (HBD Controlling Blood Pressure (CBP).
• Hemoglobin A1c (HBA1c) Poor Control.
• Child and adolescent well-care visits.
• Immunizations

These ongoing programs support you and our members, aiming to facilitate easier access to care:

Program	Description
Family unit outreach calls	Live call outreach program committed to facilitating the scheduling of doctor's appointments and fostering connections within the community to provide essential resources for women’s and pediatric health.
Weekend and extended-hour clinics	Engages with providers/clinic sites with added support of clinical staff and on-site services for members who need care outside of the provider’s normal business hours.

Quality Improvement aids in enhancing the member experience with the Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) survey

Partnering with a survey vendor to launch the Regulatory CAHPS Survey for MY 2023 to a random sample of members. Final results are reviewed to identify any trends and the findings are shared with internal stakeholders.

Improvement activities focusing on educating CAHPS stakeholders and measuring owners by partnering with operational areas to implement initiatives with the goal of improving CAHPS survey results and the overall  member experience.

Conducting quarterly root cause analysis on member pain point data to identify improvement opportunities.

Tables to compare performance goals

The tables below indicate whether clinical care and service measures improved or declined from Reporting Year (RY) 2022 to Reporting Year 2023 using MCAS, HEDIS^® measures and satisfaction surveys.

The tables also show how our performance compares to national benchmarks. While we have made improvements over the prior year, many measures remain below the 50th percentile goal. Where appropriate, N/A means not applicable, and NR means not reported due to a small denominator.

Fresno County

HEDIS/MCAS measures of clinical care (Fresno)	RY2022 score	RY2023 score	Rates compared to previous year	2022 DHCS MPL 50th percentile	RY2022 score compared to DHCS MPL
Breast cancer screening	49.11%	52.14%	↑	50.95%	↑
Cervical cancer screening	63.04%	57.08%	↓	57.64%	↓
Childhood immunization – Combo 10	35.04%	27.49%	↓	34.79%	↓
Chlamydia screening in women	59.88%	58.86%	↓	55.32%	↑
Comprehensive diabetes care: HbA1c poor control > 9%	42.64% (Inverted Rate)	37.47% (Inverted Rate)	↓	39.90% (Inverted Rate)	↓
Controlling high blood pressure	56.83%	61.73%	↑	59.85%	↑
Immunizations for adolescents – combination 2	37.23%	39.17%	↓	35.04%	↑
Timeliness of prenatal care	86.11%	89.62%	↑	85.40%	↑
Postpartum care	81.6%	84.23%	↑	77.37%	↑

Kings County

HEDIS/MCAS measures of clinical care (Kings)	RY2022 score	RY2023 score	Rates compared to previous year	2022 DHCS MPL 50th percentile	RY2022 score compared to DHCS MPL
Breast cancer screening	56.64%	58.61%	↑	50.95%	↑
Cervical cancer screening	64.17%	58.95%	↓	57.64%	↑
Childhood immunization – Combo 10	31.87%	23.84%	↓	34.79%	↑
Chlamydia screening in women	55.98%	62.15%	↑	55.32%	↑
Comprehensive diabetes care: HbA1c poor control > 9%	34.04% (Inverted Rate)	30.05% (Inverted Rate)	↓	39.90% (Inverted Rate)	↓
Controlling high blood pressure	65.1%	71.81%	↑	59.85%	↑
Immunizations for adolescents – combination 2	32.66%	29.68%	↓	35.04%	↓
Timeliness of prenatal care	91.7%	87.76%	↓	85.40%	↑
Postpartum care	87.34%	84.18%	↓	77.37%	↑

Madera County

HEDIS/MCAS measures of clinical care (Madera)	RY2022 score	RY2023 score	Rates compared to previous year	2022 DHCS MPL 50th percentile	RY2022 score compared to DHCS MPL
Breast cancer screening	56.63%	61.03%	↑	50.95%	↑
Cervical cancer screening	64.42%	61.58%	↓	57.64%	↑
Childhood immunization – Combo 10	49.64%	48.42%	↓	34.79%	↑
Chlamydia screening in women	63.15%	59.38%	↓	55.32%	↑
Comprehensive diabetes care: HbA1c poor control > 9%	40.45% (Inverted Rate)	35.93% (Inverted Rate)	↓	39.90% (Inverted Rate)	↓
Controlling high blood pressure	67.29%	67.49%	↑	59.85%	↑
Immunizations for adolescents – combination 2	50.49%	53.86%	↑	35.04%	↑
Timeliness of prenatal care	88.15%	90.37%	↑	85.40%	↑
Postpartum care	80%	87.04%	↑	77.37%	↑

Medi-Cal - Product Level Adult Survey Outcomes for CAHPS Programs

Measure of Service	RY2023  score	2022 Quality Compass® National HMO 25th percentile	RY2023 score compared to 2022 Quality Compass® National HMO 25th percentile
Customer service	86.3%	87.2	↓
Getting care quickly	81.8%	79.3	↑
How well doctors communicate	93.5%	91.0	↑

Additional information

Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569. Behavioral health providers can call 844-966-0298.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.