Medi-Cal managed care: quality improvement and value-based financial incentive program.
The implications of AB 537 are significant, as it not only seeks to standardize care quality across Medi-Cal managed care plans but also introduces a public stakeholder process. This process is intended to facilitate input from various stakeholders, such as consumer advocates and health care providers, during the planning and ongoing oversight of the quality programs. Moreover, the department will develop a publicly reported Quality Rating System based on the results from the quality improvement and performance assessment programs. This transparency aims to empower enrollees by providing them with crucial information about the quality of services they are receiving.
Assembly Bill 537, introduced by Assembly Member Arambula, aims to enhance the quality of healthcare services within California's Medi-Cal program by establishing a quality assessment and performance improvement program. Effective January 1, 2022, the bill mandates that Medi-Cal managed care plans achieve a minimum performance level (MPL) designed to improve healthcare quality and address health disparities among enrollees. The Department of Health Care Services is tasked with overseeing the implementation and evaluation of these performance standards, ensuring they effectively foster improvements in the quality of care delivered to low-income individuals.
Notably, the bill recognizes health disparities as a critical issue, defining them as variations in healthcare outcomes across different demographic groups. To address this, the Department of Health Care Services will collect and report data stratified by county, language, race, and other relevant factors. However, while there is general support for improving care quality, there may be contention regarding the adequacy of the measures established and whether they effectively capture the nuances of healthcare delivery to diverse populations. Stakeholders will need to engage rigorously to ensure that the metrics utilized are representative and sensitive to the specific needs of all Medi-Cal beneficiaries.