Home 5 Providers 5 Quality of Care 5 Performance Measures

Performance Measures

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is a tool used by more than 90% of U.S. health plans to annually evaluate health plan performance on important aspects of care like preventive health screenings. HEDIS^®performance is a way to assess CenCal Health’s effectiveness as a managed care plan compared against other health plans nationally.

For additional information regarding CenCal Health’s HEDIS program, please contact: (800) 421-2560 ext. 1609.

Highlights:

CenCal Health would like to thank providers for their support during the HEDIS^® Quality of Care Compliance Audit™, which evaluated effectiveness of care, access and availability, and other important aspects of care and service.²

CenCal Health recognized that COVID-19 may have had an impact on the outcomes of patient care during the pandemic. Therefore, it was expected that performance rates may decrease compared to prior years. Nevertheless, CenCal Health’s provider network rated among the best 5% of Medicaid plans nationally for four aspects of care, and in the top 10% for an additional two. Despite the pandemic, this year’s results mark another great performance by providers to assure members received vitally important preventive services and treatment.

Findings:

Both counties surpassed high performance levels for Timeliness of Postpartum Care.
In Santa Barbara County, high performance was also achieved for Adolescent Immunizations (Tdap, HPV, Meningococcal).
In San Luis Obispo County, high performance was also achieved for Physical Activity Counseling for Children and Adolescents.
In San Luis Obispo, opportunities for improvement include Chlamydia Screening in Women and Diabetes Screening for People with Schizophrenia or Bipolar Disorder who are Using Antipsychotic Medications.
In Santa Barbara County, opportunities for improvement include Metabolic Monitoring for Children and Adolescents on Antipsychotics, Antidepressant Medication Management, Follow-Up Care for Children Prescribed ADHD Medications, and Controlling High Blood Pressure.

Member engagement and provider partnerships are essential to achieve improved health outcomes. Detailed practice-specific
HEDIS^® Measurement Year 2021 results can be requested by contacting the Quality Measurement team, at (805) 562-1609. CenCal Health’s results are available below.

²_{NCQA HEDIS Compliance Audit™ is a trademark of the National Committee for Quality Assurance (NCQA).}