24-172m 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 Health Net Quality Improvement Program monitors the performance of clinical care and service measures using many internal and external health care data collection systems. The national benchmarks from year to year allow us to compare our results and identify areas of improvement.
Results for Medi-Cal plans are compared to the Department of Health Care Services (DHCS) 50th percentile Minimum Performance Level (MPL) for Managed Care Accountability Set (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
Quality Improvement supports you and our members to help make access to care easier with the following programs:
- Directs contact with members to address care gaps. Partners with the Healthcare Effectiveness Data and Information Set (HEDIS®) team to conduct live calls to members with many care gaps.
- Provides information about the importance of scheduling yearly wellness visits, completing screenings and tests. Also sends resources to members about how to overcome access to care barriers.
- Creates and sends educational resources and trainings to member services team members. This supports the member services team to better address member questions.
- Launches a robust flu campaign across all plans called Fluvention. Educates members and promotes the importance of getting a flu shot during the current flu season and addresses member concerns.
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 MY2023, analyzing results for trends, and sharing findings with internal stakeholders.
- Deploying off-cycle mock surveys to Medi-Cal members to assess the performance of high volume providers including office visits.
- Conducting annual CAHPS participating physician group (PPG) training webinars. The webinars cover recommendations and best practices on how provider/provider staff can improve patient satisfaction throughout all patient interactions.
- Managing CAHPS action plan and meets routinely with various stakeholder departments to discuss member experience improvement opportunities and track the progress of existing member experience programs.
Medi-Cal programs
Program | Description |
|---|---|
Outreach campaigns to address gaps in care | The goal is to improve compliance for:
|
Member incentive programs to close care gaps | Incentives for breast cancer screening, cervical cancer screening and child and adolescent well-care visits. |
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. |
Mobile mammography | Engages with providers/clinic sites to provide convenient access to breast cancer screenings by partnering with a contracted vendor, Alinea Medical Imaging, to provide equipment (mobile unit or portable coach) and state licensed technicians. |
Cozeva deployment | Enhances the data exchange with providers to support and improve quality measures, reporting and customer service. |
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 HEDIS and CAHPS data.
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.
Los Angeles County
Measures of clinical care | RY2022 | RY2023 | Rates compared to previous year | 2022 DHCS MPL 50th percentile | RY2022 score compared to DHCS MPL |
|---|---|---|---|---|---|
Breast cancer screening | 52.22% | 55.17% | ↑ | 50.95% | ↑ |
Cervical cancer screening | 51.17% | 55.12% | ↑ | 57.64% | ↑ |
Childhood immunization – combo 10 | 28.95% | 22.63% | ↓ | 34.79% | ↓ |
Chlamydia screening in women | 68.83% | 69.17% | ↑ | 55.32% | ↑ |
Comprehensive diabetes care – HbA1c poor control > 9% | 42.3% (Inverted Rate) | 38.46% (Inverted Rate) | ↓ | 39.90% (Inverted Rate) | ↓ |
Controlling high blood pressure | 59.11% | 61.31% | ↑ | 59.85% | ↑ |
Immunizations for adolescents – combination 2 | 36.67% | 38.20% | ↑ | 35.04% | ↑ |
Timeliness of prenatal care | 81% | 86.58% | ↑ | 85.40% | ↑ |
Postpartum care | 75.39% | 78.91% | ↑ | 77.37% | ↑ |
Sacramento County
Measures of clinical care | RY2022 | RY2023 | Rates compared to previous year | 2022 DHCS MPL 50th percentile | RY2022 score compared to DHCS MPL |
|---|---|---|---|---|---|
Breast cancer screening | 41.95% | 41.40% | ↓ | 50.95% | ↓ |
Cervical cancer screening | 53.62% | 53.90% | ↑ | 57.64% | ↓ |
Childhood immunization – combo 10 | 30.9% | 28.47% | ↓ | 34.79% | ↓ |
Chlamydia screening in women | 63.59% | 63.69% | ↑ | 55.32% | ↑ |
Comprehensive diabetes care – HbA1c poor control > 9% | 42.54% (Inverted Rate) | 39.45% (Inverted Rate) | ↓ | 39.90% (Inverted Rate) | ↓ |
Controlling high blood pressure | 51.58% | 60.10% | ↑ | 59.85% | ↑ |
Immunizations for adolescents – combination 2 | 40.39% | 45.01% | ↑ | 35.04% | ↑ |
Timeliness of prenatal care | 83.84% | 85.98% | ↑ | 85.40% | ↑ |
Postpartum care | 74.09% | 75.39% | ↑ | 77.37% | ↑ |
San Joaquin County
Measures of clinical care | RY2022 | RY2023 | Rates compared to previous year | 2022 DHCS MPL 50th percentile | RY2022 score compared to DHCS MPL |
|---|---|---|---|---|---|
Breast cancer screening | 34.57% | 32.80% | ↓ | 50.95% | ↓ |
Cervical cancer screening | 45.99% | 44.28% | ↓ | 57.64% | ↓ |
Childhood immunization – combo 10 | 30.63% | 25.00% | ↓ | 34.79% | ↓ |
Chlamydia screening in women | 59% | 55.88% | ↓ | 55.32% | ↑ |
Comprehensive diabetes care – HbA1c poor control > 9% | 43.64% (Inverted Rate) | 42.22% (Inverted Rate) | ↓ | 39.90% (Inverted Rate) | ↑ |
Controlling high blood pressure | 50.12% | 60.58% | ↑ | 59.85% | ↑ |
Immunizations for adolescents – combination 2 | 28.47% | 24.57% | ↑ | 35.04% | ↓ |
Timeliness of prenatal care | 81.4% | 81.42% | ↑ | 85.40% | ↓ |
Postpartum care | 70.93% | 78.66% | ↑ | 77.37% | ↑ |
Stanislaus County
Measures of clinical care | RY2022 | RY2023 | Rates compared to previous year | 2022 DHCS MPL 50th percentile | RY2022 score compared to DHCS MPL |
|---|---|---|---|---|---|
Breast cancer screening | 38.96% | 39.43% | ↑ | 50.95% | ↓ |
Cervical cancer screening | 49.39% | 44.81% | ↓ | 57.64% | ↓ |
Childhood immunization – combo 10 | 29.2%% | 23.84% | ↓ | 34.79% | ↓ |
Chlamydia screening in women | 48.48% | 50.52% | ↑ | 55.32% | ↓ |
Comprehensive diabetes care – HbA1c poor control > 9% | 45.91% (Inverted Rate) | 42.30% (Inverted Rate) | ↓ | 39.90% (Inverted Rate) | ↑ |
Controlling high blood pressure | 55.86% | 57.00% | ↑ | 59.85% | ↓ |
Immunizations for adolescents – combination 2 | 28.52% | 31.14% | ↑ | 35.044% | ↑ |
Timeliness of prenatal care | 81.85% | 77.31% | ↓ | 85.40% | ↓ |
Postpartum care | 72.22% | 71.34% | ↓ | 77.37% | ↓ |
Tulare County
Measures of clinical care | RY2022 | RY2023 | Rates compared to previous year | 2022 DHCS MPL 50th percentile | RY2022 score compared to DHCS MPL |
|---|---|---|---|---|---|
Breast cancer screening | 55.26% | 56.41% | ↑ | 50.95% | ↑ |
Cervical cancer screening | 66.85% | 69.54% | ↑ | 57.64% | ↑ |
Childhood immunization – combo 10 | 36.98% | 33.09% | ↓ | 34.79% | ↓ |
Chlamydia screening in women | 68.15% | 65.78% | ↓ | 55.321% | ↑ |
Comprehensive diabetes care – HbA1c poor | 39.58% (Inverted Rate) | 29.62% (Inverted Rate) | ↓ | 39.90% (Inverted Rate) | ↓ |
Controlling high blood pressure | 64.58% | 65.79% | ↑ | 59.85% | ↑ |
Immunizations for adolescents – combination 2 | 39.17% | 36.01% | ↓ | 35.04% | ↑ |
Timeliness of prenatal care | 93.24% | 90.87% | ↓ | 85.40% | ↑ |
Postpartum care | 85.99% | 83.11% | ↓ | 77.37% | ↑ |
Medi-Cal - Product Level Adult Survey Outcomes for CAHPS Programs
Measures of service |
RY2022 score
| RY2023 score | Compared to previous year | 2022 Quality Compass® National HMO 25th percentile | RY2023 score |
|---|---|---|---|---|---|
Customer service | 81.1% | 88.1% | ↑ | 86.7 | ↑ |
Getting care quickly | 67.7% | 75.3% | ↑ | 77.2 | ↓ |
How well doctors communicate | 88.4% | 87.7% | ↓ | 90.8 | ↓ |
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 the Health Net Medi-Cal Provider Services Center at 800-675-6110. 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.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.