State officials show little interest in providing quality of care information for poor

This post was produced for the USC Health Data Accountability Project, a joint initiative of the USC Center for Health Journalism and the Gehr Family Center for Health Systems Science.

It’s been over a decade since the California Health and Human Services Agency began publicly posting quality scores for commercial health provider groups. When they went live in 2007, many expected a scorecard for the state’s Medicaid providers would soon follow.

But more than a decade later, consumers, policy makers, and others still remain without a scorecard to track the performance of Medicaid provider groups, which now serve more than one in three Californians. And if the reply we recently received from top state officials is any measure, don’t expect one anytime soon.

“I think that there is always value in making certain information publicly available and quality scores are certainly one of those things,” said Jennifer Kent, the director of the California Department of Health Care Services, which oversees the state’s Medicaid program, known as Medi-Cal, in a telephone interview in mid-July. “It’s just not what our department is primarily focused [on] and charged with.”

But has a public scorecard for Medi-Cal provider groups – similar to what’s currently available for commercial providers in the state — ever been debated or considered by DHCS?

“No,” Kent told us. “The answer is no.”   

Without a public mandate, Medi-Cal providers have resisted any public disclosure of their quality data, even as the state’s Medi-Cal population ballooned to 13.3 million people in 2017.

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When the Center for Health Journalism and the Gehr Family Center for Health Systems Science launched an effort to obtain quality data for Los Angeles County provider groups more than a year ago, every provider group we contacted either refused to voluntarily provide their data or never replied to our requests.

The most noteworthy attempt to standardize quality measures for Medi-Cal providers in California began in 2013, with funding from the Blue Shield of California Foundation. The Integrated Healthcare Association (IHA) launched an initiative to develop a performance measure set tailored for the California Medi-Cal program. The purpose of this effort was to improve quality monitoring in the safety net.

IHA partnered with more than 50 representatives of health plans, provider groups, associations, state agencies and other organizations and proposed a core measure set consisting of “10 clinical quality measures in Medi-Cal priority areas, including chronic disease, such as diabetes care; maternity care; pediatric care; and prevention.”

More than half of the Medi-Cal health plans in the state have subsequently adopted the IHA report card to monitor quality internally, but no plan has yet used it to inform the public or policy makers about the performance of its contracted provider groups. 

According to IHA president and CEO Jeff Rideout, the California Department of Health Care Services (DHCS) – which administers the Medi-Cal program – could mandate that plans publicly report performance measures for their contracted provider groups using either the IHA measure set or another similar tool like the one used for commercial groups in the state. (The commercial scorecard is operated by the state’s Office of the Patient Advocate.)

But state leaders show no sign of embracing this approach.

“We could only take it so far,” Rideout said.

Sarah Brooks, a deputy director at DHCS, told us that although the agency public reports aggregate quality scores for its Medi-Cal health plans, it has not considered developing a quality scorecard for Medi-Cal provider groups in the state. The number of providers and medical groups in the state could make public reporting of quality scores for safety-net providers “confusing,” Brooks said.

Kent, the agency’s director, said, “I’m not sure how it would be done, especially in a county like Los Angeles.”

Nevertheless, many other large and complex health systems have made public reporting for provider groups and even individual clinicians work, including the state’s commercial health care system, as well as the Centers for Medicare and Medicaid’s 545,000 contracted health care providers.

For now, the biggest obstacle to making data on Medi-Cal providers available for the public appears to be leadership.

“Do we here at IHA believe in public reporting using standard metrics for providers serving Medi-Cal enrollees?” said Rideout. “Absolutely. With a core measure set in place and collaboration with DHCS and Medi-Cal health plans, we believe it is feasible in 2-3 years. IHA stands ready to help do it fairly and transparently as soon as the industry is ready to go there.”      

[Editor’s Note: The Blue Shield of California Foundation provides support to the USC Center for Health Journalism.]