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Local Health Plan a Top National Performer in Quality of Patient Care

Nov 21, 2019

CenCal Health’s Santa Barbara County Plan Rates Among the Best Medicaid Plans Nationwide

Recent national healthcare data shows that local health plan CenCal Health rates among the best Medicaid health plans for performance and quality. The Healthcare Effectiveness Data and Information Set or HEDIS® 2019 results affirmed top marks for CenCal Health, the public health insurance product for both Santa Barbara and San Luis Obispo Counties, with 7 aspects of care that rate among the best 5% of Medicaid plans nationwide, and an additional 7 aspects among the best 10%. Those measures of care where CenCal Health rated highest included blood glucose control and retinal eye exams for people with diabetes, timeliness of prenatal care, and rate of adolescent immunizations, among others. These top ratings mean fewer trips to local emergency rooms for patients with diabetes, and fewer who develop disabling complications such as amputations, organ failure or vision loss due to their diabetes. The high ratings also mean more member children are less likely to contract preventable childhood diseases. CenCal Health scored above the national Medicaid 90th percentile in Santa Barbara County, and above the 95th percentile in San Luis Obispo County, for nutritional and physical activity counseling of children and young adolescents. Both are vital services aimed at preventing obesity. Similarly, timely and complete prenatal care gives mothers and babies the best opportunity for healthy outcomes.

HEDIS is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare health care quality. HEDIS measurements are independently audited and produced annually to evaluate the performance of Medicaid plans throughout the nation.

In the 1970s, California was the first state to introduce Medicaid managed care. Medi-Cal is the name of the state’s Medicaid program. It is now mandatory in 57 of 58 counties for most Medi-Cal enrollees to receive services through one of 22 Managed Care Plans (MCPs). In 2018, approximately 10.4 million (80%) Medi-Cal enrollees received services through one of these health plans that provide managed care products in the counties in which they operate.

Recent analysis by the California Health Care Foundation concluded that county organized health systems like CenCal Health have, on average, better quality of care scores than counties that provided Medi-Cal services through other models such as a two-plan or competing commercial plan. Most striking was the substantially lower quality scores of the for-profit MCPs, on average, relative to the nonprofit and public MCPs.

“It reaffirms that our model of Medi-Cal health delivery in Santa Barbara and San Luis Obispo Counties, by a local, community-accountable public agency, offers higher quality care to members,” said CenCal Health CEO Bob Freeman. “This year’s HEDIS results indicate continued great performance by our network providers.”

Detailed performance results are available here on the CenCal Health website. For more information on CenCal Health, visit

About CenCal Health

CenCal Health’s mission is to improve the health and well-being of the communities it serves by providing access to high quality health services, along with education and outreach, for our membership. As a public entity, CenCal Health is a community-accountable health plan partnering with over 1,500 local physicians, hospitals and other providers in delivering exceptional patient care to more than 175,000 members – about one in four residents of Santa Barbara County and one in five residents of San Luis Obispo County. Established in 1983, it is the oldest managed Medicaid plan of its kind in the nation. CenCal Health employs close to 250 people at offices in both Santa Barbara and San Luis Obispo, and contributes approximately $50 million a month into the local economy, primarily through payments to healthcare providers who serve our membership.


NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website ( contains information to help consumers, employers and others make more-informed health care choices. NCQA can be found online at, on Twitter @ncqa, on Facebook at and on LinkedIn at

CenCal Health Contact:

Nicolette Worley Marselian (805) 685-9525 ext.1993

Media Contact:

Sheri Mobley (805) 845-5627, 213 509-9816