Performance Measures
The Healthcare Effectiveness Data and Information Set (HEDIS®) is a tool used by more than 90% of U.S. health plans to annually evaluate health plan performance on important aspects of care like preventive health screenings. HEDIS® performance is a way to assess CenCal Health’s effectiveness as a managed care plan compared to other health plans nationally. The California Department of Health Care Services (DHCS) uses both HEDIS and Center for Medicare & Medicaid Services (CMS) measures to evaluate the performance of managed care plans.
Current Performance Measures: Medi-Cal Accountability Set (MCAS)
Previous Performance Measures: Medi-Cal Accountability Set (MCAS)
Measurement Year 2024 MCAS
Measurement Year 2023 MCAS
The MCAS is a set of measures selected by DHCS to evaluate the performance of managed care plans. For additional information regarding CenCal Health’s HEDIS program, please contact: (800) 421-2560 ext. 1609.
Highlights:
CenCal Health would like to thank providers for their support during the HEDIS® Quality of Care Compliance Audit™ for Measurement Year 2024. This audit evaluated effectiveness of care, access and availability, and other important aspects of care and service.2
This year, the DHCS required Medi-Cal plans to report rates by County and by overall plan.
CenCal Health’s provider network rated among the best 5% of Medicaid plans nationally for three aspects of care, and in the top 10% for an additional seven measures. This measurement year results mark another great performance by providers to assure members received vitally important preventive services and treatment.
NOTE: High Performance Level (HPL) is meeting or exceeding the 90th percentile for NCQA National Benchmarks.
Findings:
HEDIS MY2024 Compliance Audit
High Performance (90th Percentile of higher):
- Follow-Up After Emergency Department Visit for Substance Abuse: 30-Day Follow Up (FUA)
- CenCal Health
- San Luis Obispo
- Childhood Immunizations (CIS-10)
- Santa Barbara
- Well Child Visits for age 15 months to 30 months – 2 or More Visits (W30)
- CenCal Health
- Santa Barbara
- Asthma Medication Ratio (AMR)
- San Luis Obispo
- Timeliness of postpartum Care (PPC-Post)
- CenCal Health
- Santa Barbara
- San Luis Obispo
- Breast Cancer Screening (BCS-E)
- Santa Barbara
Low Performance (50th Percentile or less)
- Childhood Immunizations (CIS-10)
- San Luis Obispo
- Developmental Screening in the First Three Years of Life (DEV)
- San Luis Obispo
Member engagement and provider partnerships are essential to achieve improved health outcomes. Detailed provider specific HEDIS® Measurement Year 2023 reports can be requested by contacting the Quality Measurement team, at (805) 562-1609. CenCal Health’s results are available below.
2NCQA HEDIS Compliance Audit™ is a trademark of the National Committee for Quality Assurance (NCQA).
MY2024 Over/Under Utilization Monitoring
Key Findings for the Over and Under Utilization Monitoring Report – Measurement Year (MY) 2024:
- In Santa Barbara County, appropriate utilization identified with rating above the Medicaid 90th percentile for:
- Well-Child Visits: Age 15 – 30 Months (2+ visits)
- In San Luis Obispo County, appropriate utilization identified with rating above the Medicaid 90th percentile for:
- Asthma Medication Ratio and Appropriate Treatment for Upper Respiratory Infection
- Within NCQA thresholds: all physical health measures
Opportunities for improvement to correct patterns of potential or actual inappropriate underutilization are needed for the following behavioral health measures rating below the MediCaid 10th percentile:
- Pharmacotherapy for Opioid Use Disorder
- Metabolic Monitoring for Children and Adolescents on Antipsychotics – San Luis Obispo
Member engagement and provider partnerships are essential to achieve improved health outcomes. Detailed provider specific HEDIS® Measurement Year 2024 reports can be requested by contacting the Quality Measurement team, at (805) 562-1609.
