California’s Office of the Patient Advocate just released new 2016-17 health plan report cards to help guide and inform consumers as they shop for coverage during the open enrollment season which is set to begin: November 1, 2016.
The report cards rate California’s 10 largest HMOs, five largest PPOs and over 200 commercial medical groups on quality and patient experience. In addition, county-level ratings of medical groups with newly added cost ratings are also included. This on-line tool makes it easier for employers and consumers to make side-by side comparisons for choosing the right plan.
What do the Report Cards Measure?
OPA uses data from the National Committee for Quality Assurance (NCQA), a non-profit that that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. To arrive at these ratings NCQA analyzes scores on clinical performance and patient satisfaction data.
Covered California’s Board of Directors voted on April 7th to require Qualified Health Plans (QHPs) selling insurance in the Exchange to reduce health disparities for their enrollees starting in 2017. Under this new initiative health plans will be provided with incentives for showing year-over-year improvement in key target areas where disparities are well-documented: diabetes, hypertension, asthma, and mental health. To achieve these goals, health plans will also be required to increase the percentage of self-reported demographic data of their membership annually with an 80% goal by the end of 2019.
“We are raising the bar not just for California but for the nation,” declared Peter Lee, Executive Director of Covered California. Covered California’s new contract requirements included as part of Attachment 7 to the QHP contract, includes 45 separate and distinct new requirements on plans focused on improving the quality of care for Covered California enrollees. These new requirements which were the culmination of six months of stakeholder discussions led by Covered California’s Chief Medical Officer, Dr. Lance Lang also include important new requirements to improve hospital safety and promote primary prevention and wellness, amongst other initiatives.
Covered California Sees Strong Enrollment Numbers in 2016: Covered California released a detailed breakout of its 2016 enrollees at its Board meeting on February 18. Nearly 440,000 new enrollees had selected a Qualified Health Plan (QHP) as of February 6, 2016. Low-income (88%) and communities of color (66%) continue to represent the majority of Exchange enrollees with Asians at 20%, Pacific Islanders at >1%, Black or African-American at 4%, Latino at 36%, American Indian or Alaskan Native at > 1%, and multiple races/other at 7%.
While Covered California’s preliminary enrollment numbers are strong, they provide an incomplete picture of the enrollee population as close to one-third of enrollees (119,510) did not respond to demographic questions. Covered California plans to provide additional data on its 2016 enrollee population including information on the written and spoken languages of its enrollees at a later point this year.
California’s Office of the Patient Advocate (OPA) released its 2015-16 Health Care Quality Report Cards last week. The new report cards shed light on the quality of care under a variety of health care providers and plans, including California’s 10 largest HMOs, the six biggest PPOs, and more than 200 large medical groups covering 16 million consumers in California. The data is drawn from claims data and patient surveys.
The report cards are timely as consumers gear up for 2016 open enrollment, which begins Nov. 1, 2015, and continues through Jan. 31, 2016. With the release of the report cards, consumers should have an easier time shopping for coverage. Each HMO and PPO is evaluated on their overall medical care and for how it treats certain conditions like asthma and cancer as well as its behavior and mental health care. Further, the report card provides a deeper evaluation on how a health plan treats certain conditions through specific clinical indicators of good care. This helps consumers understand what they should expect from their coverage.
This month, the Centers for Medicare & Medicaid Services (CMS) released a comprehensive report to promote equity in the Medicare program, which is relied upon by millions of older adults across the country. The report, The CMS Equity Plan for Improving Quality in Medicare, offers a four-year strategy to reduce disparities in communities of color, rural communities, and the LGBTQ population.
In today’s California Healthline, CPEHN’s Executive Director, Sarah de Guia, applauded CMS’s effort and noted the imperative of improving Medicare for communities of color and the LGBTQ population:
"We are heartened to see CMS focus on the persistent disparities impacting communities of color, the LGBT community, rural communities and persons with disabilities," said Sarah de Guia, CPEHN executive director.
"This information will provide us a path forward to understanding the impacts of health disparities and identify ways to reverse the inequities that result from them," de Guia said.
In order to adequately address health disparities, it is important to have as much information as possible on where inequities exist and what populations are most impacted. One of the best ways to address disparities is through collection of disaggregated data on race, ethnicity, and language spoken. One of the key aspects of CPEHN’s policy agenda is enhancing the collection and use of this data to develop more detailed and targeted strategies for reducing disparities.
This week, the California Health Report looked at how data collection can be used to reduce disparities experienced by children in the Medi-Cal program. In particular, the story focused on how children’s health advocates are pushing for Medi-Cal to report on more quality measures besides the minimum required:
The federal Centers for Medicare & Medicaid Services, which regulates the Medi-Cal program, has a list of 24 child health indicators this year. States are required to report on the quality of their low-income health programs, but filing data on the 24 indicators is optional…
California reported on 13 of the indicators in April and expects to report on the same ones when it files next year’s report, which will use 2015 data, said DHCS spokeswoman Carol Sloan.
Advocates argue that California should take the lead in reporting more quality measures because it has the largest Medicaid population in the country.
CPEHN’s Cary Sanders is featured in the story and discusses how reporting on more quality measures in Medi-Cal would help inform efforts to reduce disparities.
Over 100 advocates from across the state gathered at the Sierra Health Foundation in Sacramento earlier today for CPEHN’s sixth Focus on Equity: Communities of Color in a Post-ACA California convening. The event, co-hosted by OnTrack Program Resources, highlighted a number of topics that impact health in California’s communities of color, including health care quality, behavioral health integration, and access to health care for the remaining uninsured, particularly undocumented immigrants.
After the popularity of our events in Oakland, Fresno, Los Angeles, San Diego, and Riverside, we were invited by OnTrack to continue the discussion in the state capital. The event began with a presentation by CPEHN Executive Director Sarah de Guia that touched on each of the event’s topics.
She focused on how communities of color, who represent a majority of the state’s population, have the most to gain from successful implementation of the Affordable Care Act (ACA). She also pointed to the increased enrollment of Latinos and African Americans during Covered California’s second open enrollment period as a sign that the law’s programs are starting to have their intended impact.
The work of the Agency for Healthcare Research and Quality (AHRQ) is an invaluable resource for us at CPEHN and for everyone working on achieving equity in health. As the leading federal agency for health services research, AHRQ’s annual National Healthcare Quality & Disparities Reports provide some of the most comprehensive data available on how our health care system is performing, particularly in regards to communities of color.
But AHRQ is in peril. The recent appropriations bill from the House Labor, Health and Human Services, Education and Related Agencies Subcommittee has proposed to eliminate AHRQ. If this legislation advances, we would be left without a source of data that is essential to efforts to reduce inequities, improve quality, and reduce costs in our health care system.
But all hope is not lost for AHRQ! There is still time for you to take action and stop this legislation. You can share your support through this useful advocacy tool on AcademyHealth’s website. Every voice counts and your support could help save this vitally important resource.
The data available through AHRQ informs our work at CPEHN on an almost daily basis, and we have a number of AHRQ resources available on our website. AHRQ helps us identify inequities in a variety of health care quality measures, including:
Yesterday in Sacramento, Health Affairs (a leading journal of health policy and research), the Blue Shield of California Foundation, and the California HealthCare Foundation hosted an event,The California Medi-Cal Waiver: Perspectives on Promoting Health System Improvement in California. The event highlighted the opportunities presented by the renewal of California’s 1115 Medi-Cal waiver to transform California's health care system so that it is better able to meet the needs of its new enrollees.
Earlier this year, CPEHN’s Sarah de Guia discussed how the waiver offers a great opportunity to promote health equity for Medi-Cal enrollees, a majority from communities of color:
The waiver gives states like California additional flexibility to design and improve their Medicaid program (Medi-Cal in California) and Children’s Health Insurance Program (CHIP). With the waiver, states can expand eligibility, provide additional services not typically covered, and use innovative service delivery systems that improve care, increase efficiency, and reduce costs, otherwise referred to as the “Triple Aim.”
What’s missing from these conversations is a focus on a fourth aim, promoting health equity… Through our participation in the 1115 waiver renewal process, CPEHN is working to bring awareness to the historic inequities in health outcomes that our communities experience, and the need for innovative policy proposals to help reform traditional health care coverage into systems that can provide meaningful access to services for our communities.
Yesterday’s event also included discussion about health equity and how the health care system can better serve California’s diverse communities of color. Here are some highlights:
First, our Inland Empire convening, cohosted by the California Partnership and the Community Clinic Association of San Bernardino County, will now be June 5th in Riverside at the United Domestic Workers Community Room, 3600 Lime Street, Suite 421. The agenda will be the same and we are excited to discuss Health for All efforts to extend coverage to California’s immigrant population, behavioral health integration, and including equity when considering ways to improve quality of care. We’d also like to hear from residents in the Inland Empire about the unique health needs your communities face. Register today and we can work together to improve health in Riverside and San Bernardino Counties.