Can the leaders of health plans serving Medicaid recipients compete when it comes to quality outcomes? They absolutely can. Indeed, CenCal Health, the Santa Barbara-based health plan serving Medi-Cal (what Medicaid is called in California) recipients in Santa Barbara and San Luis Obispo Counties on the California coast, has demonstrated outstanding results when it comes to caring for children, new mothers, and members with diabetes.
As an Oct. 6, 2022 press release noted, “CenCal Health, the community health plan for Medi-Cal in Santa Barbara and San Luis Obispo counties, received high marks in two respected professional health care assessments– the national Healthcare Effectiveness Data and Information Set (HEDIS®), and the state-wide report on Consumer Assessment of Healthcare Providers and Systems (CAHPS®) [from the federal Agency for Healthcare Research and Quality, AHRQ]. With results released in 2022, the findings in both annual audits concluded that, in multiple categories, CenCal Health and its providers delivered exceptional care to child members, as well as members that are new mothers and members with diabetes. According to the HEDIS results for pediatric members of the nation’s Medicaid plans, San Luis Obispo County rated in the top 5 percent for weight assessment, physical activity counseling, and nutrition counseling for children and adolescents. Santa Barbara County rated in the top 10 percent nationally for meningococcal, Tdap and human papillomavirus (HPV) immunizations for adolescent plan members, ages 9-13.”
What’s more, the press release noted, “In addition, for the second year in a row, both counties covered by CenCal Health received the highest HEDIS rating – top 5 percent in the nation – for timeliness of women’s postpartum care. This year, the community health plan also rated in the top 10 percent nationally for having a low rate of diabetic members with HbA1c poor control. This means that a higher percentage of CenCal Health members with diabetes had better blood glucose control compared to Medicaid members with diabetes in other plans nationwide. CenCal Health’s HEDIS measurements are independently audited and reported annually to the National Committee for Quality Assurance (NCQA) to demonstrate the quality of care rendered by CenCal Health’s providers.”
And it quoted CenCal Health CEO Marina Owen as stating that “CenCal Health prides itself on partnering with committed and compassionate physicians, clinics, hospitals and health care specialists in both counties. It is because of these outstanding provider partners – with support from CenCal Health – that our organization and community have achieved these excellent results in both evaluations.”
CAHPS is the health care survey on patient experience that asks consumers and patients to report on and evaluate their experiences with health plans, providers and healthcare facilities. With funding from the California Department of Health Care Services (DHCS), the Health Services Advisory Group (HSAG) is the designated External Quality Review Organization that administered the current CAHPS survey. DHCS and CenCal Health use CAHPS results to improve patients’ experiences with care.
The press release noted that, “In 2021, HSAG surveyed consumers in 25 health plans in California, ranking CenCal Health No. 1 in Customer Service for Child Members, No. 2 in Overall Rating of Health Plan for Child Members, and No. 3 in Overall Rating of Personal Doctor for Child Members.”
And it quoted Tamara Battle, M.D., of Central Coast Pediatrics, as stating that, “During the pandemic, we saw diminished preventative care-seeking behaviors in our local population. Recovery has been an important part of supporting the health and well-being of our patients. Central Coast Pediatrics strives to assist families in achieving health outcomes that enrich the lives of children in our community.”
The measurement period for the latest HEDIS report ended December 31, 2021. For CAHPS, the survey was available to consumers from February to May 2021, with ratings representing members’ experiences of care and service over the prior six months.
Recently, Healthcare Innovation Editor-in-Chief Mark Hagland spoke with CEO Marina Owen about how the praiseworthy outcomes have been achieved, and the journey that she and her colleagues are on to optimally serve their communities. Below are excerpts from that interview.
Tell me about the overall strategies you and your colleagues have been pursuing at CenCal Health that have led to such strong results in terms of plan member outcomes?
We’re in our 40th year at CenCal, and for at least the last 15, years, we’ve been emphasizing a pay-for-performance strategy, around maximizing quality of care and sustaining a top rating among California’s health plans. And that means investing significant amounts of funding into primary care and tying that to quality outcomes. Many plans invest in primary care; what’s exceptional is the length of time we’ve been doing this, and the significant amount of technical assistance—we provide scorecards, and access to portals that provide significant amounts of information, so we know which patients aren’t receiving the care they should; and we go into physician offices and educate and support medical assistants and back office staff, and really help them with their EHRs [electronic health records]. So what we’ve been doing has been creating systems in the practices that help alert very, very busy physicians and office staff to the fact that service is necessary. So one of the most important things we do is to make sure there are alerts to providers—we make sure that if a visit needs to occur, there are touchpoints for that.
So that’s the main strategy, and once a year, we visit primary care practices for routine audits of their practices, and we use as learning opportunities as well. So we talk with them about quality. Another thing that’s unique is the level of engagement we’ve achieved: there’s a provider advisory board, a clinical advisory board; so many of the practice leaders are actually on the committees that design the best practices. So we’re a smaller organization, but we make sure that the best practices are tailored to the physician practices.
And we engage the patients, and that includes programs member incentives or engagement activities; the first is that we’ve had a well-baby performance improvement campaign. We also have a healthy mothers campaign. And we have a “no more HPV” campaign; and that actually won a national NCQA award nationally for innovation. That won the state MediCal innovation award and the NCQA award. They have an iPad where the parents and teens could answer questions. That was really popular; people like to use iPads while waiting in waiting rooms. I’ll send you the information on that.
What have been the critical success factors in all that work? And how have you achieved a high level of engagement with providers?
Very good question. Prior to this, I was the COO at a MediCal program, and before that, a director of provider services. And my experience has been that the patient practices that work with this population are incredibly mission-driven; they wouldn’t do it otherwise. And they’re all very unique, and often serve Almost hidden cohorts of people. Practices specialize in certain patient populations. So what’s really helpful is taking the time to understand the makeup of each practice, knowing there’s not a one-size-fits-all approach, and understanding what specific technical assistance or support would be needed. So, it's incredibly tailored. We like to say that MediCal is so local and is at the neighborhood level. So the strategy, patient incentive, or patient engagement brochure tool—what might work on one side of town won’t work on the other. We need micro-strategies.
In that regard, we’ve paired each physician practice with two things: both a provider service representative dedicated to their practice; and a quality improvement specialist. So when we engage the provider, we know their patient panel, know the patients they serve, know the names of all their staff members, know which EHR they use, know the barriers they face. And we have data, and can provide that specific assistance; and it’s different for each practice. Sometimes, what they need is scheduling expertise; sometimes, data feeds, sometimes clinical expertise on best-practice guidelines; it’s unique. So we take a listening posture; w don’t arrive believing we know everything.
How do you look strategically at data?
We think we have to leverage data and create insights for any innovation to occur. It fuels our strategy. And every performance plan we create is first based on what the data tells us. And there’s so much distrust in the data; so we have to be able to capture and validate, and then present to the physicians, for them to tell us what we’re not capturing, so we get a complete picture. It’s absolutely an iterative process. And we like to use data to build on strengths. It’s helpful to look at gaps in care, even as you excel. Almost every practice sees metrics where they excel and metrics where they’re not. So we begin by looking at the data, and then examine areas where we might improve.
And we continue to learn as the data shifts. There’s nothing more important than getting, understanding, and validating data, to drive our actions. At CenCal, we don’t just try a lot of different things at the same time; we like to create a hypothesis with data, test it, and discontinue or continue the activity, based on the outcome.
