Medi-Cal Managed Care Performance Dashboard Released September 17, 2015

Transcription

1 Millions MediCal Managed Care Performance Dashboard Fig 11 Enrollment By Population Families ACA Expansion Children Duals SPDs Apr14 May14 Jun14 Jul14 Aug14 Sep14 Oct14 Nov14 Dec14 Jan15 Feb15 Mar15 All 7,155,4 7,34,7 7,56,56 7,39,67,111,69,356,175,656,315,65,597,99,341 9,,039 9,44,717 9,373,110 SPDs 65,90 653, ,19 653,5 65,33 651,13 651,91 650,39 669, , , ,53 Duals 4, ,51 456,94 43,76 517, , , , ,94 755,1 7,6 5,759 Children 797,956 11,154 33,49 57,696,57 95,603 9,49 950, , ,466 97,46 994,4 ACA Expansion 93,36 1,015,599 1,173,114 1,361,644 1,50,050 1,00,596,03,4,190,497,1,59,44,143,476,909,576,3 Families 4,3,3 4,4,770 4,469,933 4,43,46 4,479,59 4,465,99 4,477,109 4,473,01 4,43,95 4,404,439 4,337,563 4,315,046 Notes: SPDs are MediCal only; SPD children are categorized as SPD's Children are exclusively Optional Targeted Low Income (up to 66% FPL) whose parents' income is too high for MediCal; Families population includes parents and children who mostly qualify for TANF Millions Fig 1 Enrollment by Plan Model Families Children SPDs Duals ACA Exp 6 6.% 4 1.6% 10.6% 3.7% 1.3% COHS GMC TwoPlan RM CMC All,00,33 994,569 5,9,0 34,703 13,367 Duals 11% 7% 7% 1% 10 SPDs 6% % 7% % Children 13% 1% 1 11% ACA Exp % % 7% 35% Families 4% 45% 49% 45% Fig 13 MediCal Managed Care vs. FFS 5% MC FFS 75% 6 4 Fig 14 Choice and AutoAssignment Rates 7%.% 10.6% 7.5% 46.1% Choice AutoAssigned Passive + Prior Notes: Passive + Prior includes transitioning populations, members defaulted because they were previously a member, or if other family members were already assigned to the plan. Date is effective date of plan enrollment. Choice/plan assignment occurred during the previous month. Note: Data in this dashboard is preliminary and subject to change Page 1 of 19

2 MediCal Managed Care Performance Dashboard Fig 1 MediCal Managed Care Members by Age (Includes SPD and Duals) % 144 6% 7% 10 5% 15 13% % % % Fig MediCal Managed Care Members by Race and Ethnicity (Includes SPD and Duals) 1% 11% 1% 9% Hispanic 47% White Asian/Pacific Islander Other/Unknown AfricanAmerican Fig 3 MediCal Managed Care Members MediCal Only SPDs by Age % 4% % % % 144 3% 10 4% Fig 4 MediCal Managed Care Members Dual Eligibles by Age 69% 144 9% % Fig 5 MediCal Managed Care Members Percent of Total by Age/Gender (Includes SPDs and Duals) Age Group Female 4.9% 4.9% 4.% % 5.1% 54.5% 6.3% Male 51.1% 51.1% 51.% % 41.9% 45.5% 37.7% Total 161,45 1,17,945 1,43,60 1,56,37 504,74,399,330 1,66, ,054 Note: Data in this dashboard is preliminary and subject to change Page of 19

3 MediCal Managed Care Performance Dashboard UTILIZATION: Statewide Fig 31 ER Visits per 1,000 Member Months Fig 3 ER Visits with an IP Admission per 1,000 Member Months Visits Visits Fig 33 IP Admissions per 1,000 Member Months Fig 34 Pharmacy Claims per 1,000 Member Months Admissions Claims 4,000 3,000,000 1,000 3, Fig 35 OP Visits per 1,000 Member Months 3,000 Visits,000 1,000,03 1, Note: Data in this dashboard is preliminary and subject to change Page 3 of 19

4 MediCal Managed Care Performance Dashboard ACCESS: Grievances for Q1 015 Statewide Fig 41 Grievances by Type Fig 4 Grievances by Ethnicity Fig % % 3.4% Quality of Care/ Services Other Benefits/ Coverage Accessibility 16.4% 1.9% 5.9% 36.% White Hispanic Other/Unknown African American 4.5% 10.% 3.5% 36.% ACA Other SPD Dual Children 0.5% Referral. Asian/Pacific Islander 5. Fig 44 Fig 44 Grievance Resolution by Type Fig 45 Grievances by Age Resolved in Favor of Member Resolved in Favor of Plan Unresovled % Accessibility Benefits.7% 65.7% 15.5% 3.1% 1.%.% % Referral 3.3% 15.3% 1.3% Quality of Care/ Services Other 7.% 73.4% 5.3% 5.6% 1.% % 4.7% 4.9% 4.5% 1.9% 7. < Fig 46 Grievances by Age and Gender Age Group Grievances by Gender Female 0.7%..1%.3% 1.% 19.9%. 4.6% Sub Total Male 0.%.%.%.% 0.7% 9.4% 1.1%.4% Sub Total Grievance data displayed on this page represents planreported data. Total Note: Data in this dashboard is preliminary and subject to change Page 4 of 19

5 MediCal Managed Care Performance Dashboard QUALITY AND SATISFACTION Fig 1 HEDIS 015 Aggregated Quality Factor Score MPL HPL Weighted Average: % Rates Note: The Aggregated Quality Factor Score (AQFS) is a single score that accounts for plan performance on all DHCSselected Health Effectiveness Data and Information Set (HEDIS) indicators. It is a composite rate calculated as percent of the National High Performance Level (HPL). The High Performance Level is 10. The Minimum Performance Level is 4. The State Average is 6. Note: Data in this dashboard is preliminary and subject to change Page of 19

6 MediCal Managed Care Performance Dashboard Fig 11 Satisfaction CAHPS 013 (Adult): Rating Customer Service KP North Sacramento CalOptima Orange KP South San Diego CCHP Contra Costa Molina Sacramento CenCal San Luis Obispo CCAH Monterey/Santa Cruz Health Net Kern CCAH Merced IEHP Riverside/San Bernardino HPSJ San Joaquin KFHS Kern ABC Madera Partnership Napa/Solano/Yolo Health Net Sacramento Molina Riverside/San Bernardino GCHP Ventura Partnership Mendocino Care First San Diego HPSM San Mateo CenCal Santa Barbara ABC Kings SCFHP Santa Clara CHG San Diego Partnership Marin ABC San Francisco ABC Contra Costa Alameda Alliance Alameda CalViva Fresno LA Care Los Angeles ABC Sacramento Molina San Diego Partnership Sonoma ABC Santa Clara Health Net Los Angeles Health Net San Diego Health Net Tulare SFHP San Francisco CalViva Madera CalViva Kings Health Net Stanislaus ABC Tulare ABC Fresno ABC Alameda Rate MediCal Managed Care members were asked to assess how often members were satisfied with customer service. The rate is the percentage of members who responded "Always" or "Usually" to the specific questions. If the Plan had fewer than 5 respondents for a measure, the results were suppressed. Note: Data in this dashboard is preliminary and subject to change Page 1 of 19

7 MediCal Managed Care Performance Dashboard Fig 11 Fig 191 Satisfaction CAHPS 013 (Child): Rating Customer Service Health Net Stanislaus KP North Sacramento Partnership Napa/Solano/Yolo ABC Alameda Partnership Mendocino KP South San Diego HPSJ San Joaquin Partnership Marin Molina San Diego CalViva Madera ABC Tulare ABC Contra Costa SFHP San Francisco Molina Riverside/San Bernardino IEHP Riverside/San Bernardino CHG San Diego CCHP Contra Costa LA Care Los Angeles HPSM San Mateo CenCal Santa Barbara Care First San Diego CalViva Fresno Health Net Los Angeles CalViva Kings SCFHP Santa Clara Health Net Kern Health Net San Diego Molina Sacramento KFHS Kern CCAH Monterey/Santa Cruz ABC Fresno CCAH Merced ABC Sacramento Health Net Tulare GCHP Ventura ABC Santa Clara Health Net Sacramento Partnership Sonoma CenCal San Luis Obispo CalOptima Orange ABC San Francisco Alameda Alliance Alameda ABC Madera ABC Kings Rate MediCal Managed Care members were asked to assess how often members were satisfied with customer service. The rate is the percentage of members who responded "Always" or "Usually" to the specific questions. If the Plan had fewer than 5 respondents for a measure, the results were suppressed. Note: Data in this dashboard is preliminary and subject to change Page 19 of 19