Thanks to collaborations between the Alliance, physicians and medical centers in its network, and the communities it serves, the Alliance was recognized as one of the state’s “Overall Most Improved” Medi-Cal managed care plans in October by the California Department of Health Care Services (DHCS).
From a field of 53 regions in California, the Alliance in Santa Cruz and Monterey Counties rose to become one of the top five regions in the state—ranking fourth in the state from 14th in the state the year before—based on HEDIS® (Healthcare Effectiveness Data and Information Set) ratings.
The Alliance scored in the 90th percentile in ten measures in California from the DHCS—signifying “High Performance” status in diabetes care, screening for cervical cancer, childhood and adolescent immunizations, prenatal and postpartum care, well-child visits, and decreased antibiotic use, among several other HEDIS measures. HEDIS, which is developed and maintained by the National Committee for Quality Assurance (NCQA), is the most widely recognized health plan assessment program in the nation.
Bishop noted that the Affordable Care Act enabled a significant portion of Santa Cruz’s population—not previously insured at all—to get coverage through the Alliance. “Take cervical cancer, for example; with early detection, patients who would not otherwise have been insured are able to avoid the costly and complex treatments that might have been needed if the cancer were to have progressed.”
Incentives for doctors and clinics are provided by the Alliance to inspire the pursuit of NCQA health goals—as well as webinars, in-person site visits and extensive outreach.
Providing subject-matter experts to clinics; collecting data on low-performance clinics; grant funding; and providing practice coaching and quality improvement staff so clinics can improve are just some of the Alliance’s many improvement tools.
Alliance Honors Its 2018 Health Care Network for High Performance
To acknowledge providers in its network for their partnership and performance on HEDIS measures, the Alliance last year launched its own recognition program, presenting top physicians and clinics in the county with its own Gold, Silver and Bronze Quality Awards—based on the number of Alliance members each clinic serves.
Dori Rose Inda
Dori Rose Inda is CEO at Salud Para La Gente (Salud), which won the Silver Quality Award from the Alliance, in the category of 1,000 plus Alliance patients.
“This award shows our ability to affect our patients every day in a way that really improves their health,” she said, “That’s really what this award is about, measuring that people are healthier because of the care we are giving.”
Salud ranked high in improvements for diabetes care, immunizations, prenatal care and nutritional counseling during well child visits.
“What’s exciting for me,” Chief Medical Officer at Salud Amy McEntee said, “is that these categories are about prevention. That’s going to help everyone in the long run. And diabetes care is crucial. That’s a hard measure to move, and it takes a whole team to move it.”
This year’s HEDIS scores reflect a record high performance for the Alliance and its provider network. “What these scores mean to me,” Stott said, “is that Medi-Cal health plans can achieve high-performance national benchmarks and assurance of excellent care delivery for our members.”
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Santa Cruz County Alliance Health Care Quality Awards Winners
100-1,000 Medi-Cal Members
- Gold Quality Award: Dr. Josefa Simkin, Freedom
- Silver Quality Award: Palo Alto Medical Foundation, Aptos
- Bronze Quality Award: Dr. Robert Weber, Watsonville
1000+ Medi-Cal Members
- Gold Quality Award: Plazita Medical Clinic, Watsonville
- Silver Quality Award: Salud Para La Gente, Watsonville
- Bronze Quality Award: City of Santa Cruz Watsonville Health Center, Watsonville
90th Percentile Award, Pediatric Clinics
- Pediatric Medical Group, Freedom
- Dr. Madhu Raghavan, Watsonville
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Central California Alliance for Health, established in 1996, serves approximately 350,000 members in Santa Cruz, Monterey and Merced counties. The award-winning plan employs nearly 600 staff members in the three counties and manages a budget of $1.1 billion.
Visit www.ccah-alliance.org for more info.
