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The California Department of Managed Health Care (DMHC) has adopted standard health equity and quality measures for health plans with the goal of ensuring the equitable delivery of high-quality health care services for all enrollees.
“With the adoption of these standard measures for health plans we are furthering our commitment to improve the delivery of quality health care as a key measure to advance equitable health outcomes for all,” said DMHC Director Mary Watanabe. “Health plans will be held to higher standards on delivering quality care in more equitable and meaningful ways to enrollees. I want to thank all of the dedicated members of the Health Equity and Quality Committee for their thoughtful work in making recommendations on the measures.”
Assembly Bill (AB) 133 (2021) required the DMHC to adopt standard health equity and quality measures that health plans will report on annually to the Department. To identify the measures, the Department convened a Health Equity and Quality Committee of diverse experts including representatives of consumers, health plans, providers, government agencies and research entities. The Committee held several public meetings during 2022, and made recommendations to the DMHC Director on the standard health equity and quality measures.
“The Committee’s recommendations are meant to improve the overall quality of care for all health plan enrollees, and to address health equity in ways to better understand the drivers of health disparities in order to more fully address inequities in the delivery of care,” said Diana Douglas, a Committee member and director of policy and advocacy for Health Access California. “The goal is to improve and promote optimal and more equitable results in terms of health care quality, effectiveness, and ultimately, population health.”
The Committee considered state and national trends related to health equity and quality as well as the intersection of multiple patient characteristics that contribute to disparate health outcomes, including race, ethnicity, sexual orientation, gender identity, language, age, income, and disability status. The measures represent aspects of health which are important to advancing equity and quality in preventative care, maternal health, chronic conditions, and mental health across pediatric, adolescent, and adult populations.
The DMHC adopted all health equity and quality measures recommended by the Committee, listed here:
- Colorectal Cancer Screening
- Breast Cancer Screening
- Hemoglobin A1c Control for Patients with Diabetes
- Controlling High Blood Pressure
- Asthma Medication Ratio
- Depression Screening and Follow-Up for Adolescents and Adults
- Prenatal and Postpartum Care
- Childhood Immunization Status
- Well-Child Visits in the First 30 Months of Life
- Child and Adolescent Well-Care Visits
- Plan All-Cause Readmissions
- Immunizations for Adolescents
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey, Version 5.0 (Medicaid and Commercial): Getting Needed Care
Additionally, the DMHC will require plans to stratify the data reported by race and ethnicity using the National Committee for Quality Assurance’s (NCQA) race and ethnicity methodology. More information on the measures and requirements can be found in the Committee report and the DMHC’s All Plan Letter.
All DMHC-licensed full service and behavioral health plans, including Medi-Cal managed care plans, will be required to start collecting data on the measures in 2023 and report this data to the DMHC starting in 2024. The DMHC will begin publishing a Health Equity and Quality Compliance Report on the data and information reported by health plans starting in 2025.
