Report 2018-115 Recommendation 1 Responses

Report 2018-115: Department of Health Care Services: Although Its Oversight of Managed Care Health Plans Is Generally Sufficient, It Needs to Ensure That Their Administrative Expenses Are Reasonable and Necessary (Release Date: April 2019)

Recommendation #1 To: Health Care Services, Department of

To help identify successful improvement projects, by September 2019 DHCS should require health plans to annually report the results of those projects they plan to continue or expand to other locations.

1-Year Agency Response

DHCS created an Annual Quality Improvement Survey Process Document describing the annual survey development, the procedures to send to the MCPs, the process to compile the results, and the steps to share the results via the Quality Improvement Toolkit and other forums as appropriate. The Process Document includes specific details on what questions require a response to ensure MCPs report annually on the results of projects they plan to continue or expand, and the steps DHCS takes if MCPs fail to respond to the required questions as directed.

California State Auditor's Assessment of 1-Year Status: Fully Implemented

6-Month Agency Response

DHCS continues to share promising practices through all avenues previously discussed, and continues to identify new ways to share promising practices. DHCS conducted the annual Quality Improvement Survey with the Managed Care Plans (MCP) and incorporated new questions into that survey, requiring the MCPs to provide information on their successful interventions and interventions that they are continuing to spread.

California State Auditor's Assessment of 6-Month Status: Partially Implemented

DHCS provided evidence demonstrating that it requested the health plans to report the results of those improvement projects they plan to continue or expand to other locations based on the health plans' 2018 activities. However, it did not provide evidence demonstrating that it requires health plans to annually report the results of those projects they plan to continue or expand to other locations.

60-Day Agency Response

DHCS currently compiles information from MCP's PDSA, performance improvement projects, and CAP submissions to track the types of interventions that MCPs are exploring. DHCS shares promising practices as well as lessons learned based on this information with MCPs through individual MCP technical assistance, Quality Collaborative Teleconferences attended by all MCPs, Quality Improvement Highlights that are sent to all MCPs, and a variety of in person meetings, including the quarterly Medical Directors Meeting.

DHCS also has developed a Quality Improvement Toolkit that allows MCPs to access many applicable resources in one location through an external SharePoint site.

DHCS will engage further with MCPs to share best practices and issue a document summarizing them. DHCS will work with MCPs to identify appropriate best practices to be implemented in their respective geographic areas.

Finally, DHCS is including childhood immunizations as a measure under its Value Based Payment initiative that is being funded by Proposition 56 funds with the intent of driving improvement in reporting and utilization of this metric on a statewide basis.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2018-115

Agency responses received are posted verbatim.