Performance Measurement & Reporting in Medi-Cal Managed Care
Enrollment in Medi-Cal (California’s Medicaid) has reached 12 million—nearly one-third of the state’s population—with two million members becoming eligible since the Affordable Care Act took effect. Around nine million of those members obtain their care through managed care plans. As enrollment increases and the Medi-Cal population shifts to managed care, an imperative is emerging for consistent performance measurement that can ease the measurement burden for providers, provide comparative information to stakeholders, and create a foundation for payment incentives that could help incentivize high-quality, more affordable care.
Based on our experience with performance measurement in the Commercial HMO and Medicare Advantage populations, IHA has made a concerted effort over the last several years to maximize the value we bring to Medi-Cal and the safety net through a variety of projects that range from piloting performance measurement and reporting at the physician organization level to providing technical assistance to the California Department of Health Care Services on the development of the next round of the State’s 1115 waiver application to CMS.
The current focus for IHA is on creating a common measure set for all Medi-Cal Pay for Performance programs.