Performance Measurement & Reporting in Medi-Cal Managed Care
Medi-Cal—California’s Medicaid program—now covers more than 13 million people, or about a third of the state’s population. Almost 4 million people have gained Medi-Cal coverage since the Affordable Care Act took effect, bringing enrollment in Medi-Cal managed care plans to about 11 million low-income adults and children. As Medi-Cal managed care enrollment increases, there is a growing imperative to develop consistent performance measures that can ease the reporting burden on providers, provide comparative information to stakeholders, and create a foundation for payment incentives to advance high-quality, affordable, patient-centered care.
Based on our experience with performance measurement in the commercial and Medicare Advantage populations, IHA has partnered with plans, providers, policymakers, and other stakeholders to maximize the value we bring to Medi-Cal and the safety net through a variety of projects ranging 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 previous round of the State’s 1115 waiver application to CMS. Our current focus is working with stakeholders to standardize performance measurement and reporting across Medi-Cal health plans.