Medi-Cal Managed Care: Raising the Bar for Quality and Outcomes

January 22, 2015

To realize better health outcomes, Medi-Cal Managed Care (MMC) plans have many challenges to confront. Plans must tackle the tasks of ensuring that provider networks are of sufficient size, coordinated, high performing in service quality, and engaging patients to be critical partners in improving their health. These achievements require a great deal of investment and the right incentives to maintain systems in the longer term.

Health plans, providers, and the California Department of Health Care Services (DHCS) are implementing new policies and systems in service of these aims. These innovations and advancements are particularly important for many newly eligible beneficiaries who have a different health profile and care needs than previously eligible beneficiaries. Health plans are addressing these challenges in a variety of different ways, which depend on their local managed care environment, provider networks, and service delivery models. This paper highlights some of these efforts across the state, with a focus on successes that different organizations have seen and what promise they might hold in the future.

For this project, we interviewed a range of stakeholders from health plans, providers, independent practice associations, community clinics, and county health departments. Their opinions and expertise were compiled in the following paper and considered in our recommendations.

ITUP recommends that:
1. DHCS take on a more active oversight role
2. DHCS and MMC plans standardize data collection and increase transparency in performance reporting to the public and to providers
3. DHCS serve as an assertive facilitator and promoter of innovative best practices in value-based payment and delivery system reform
4. MMCs expand member engagement programs to reach new managed care populations
5. DHCS develop mental health and substance use disorder services quality performance metrics
6. All safety net delivery systems use the ยง1115 waiver to coordinate managed care with carved out services, with the aim of integrating delivery systems as soon as possible
7. MMCs include carved out providers in risk and shared savings programs

Download the paper here.

managed care pie chart