Cal MediConnect Plans Met 75% of State and Federal Quality Withhold Measures in 2017

Last week, the Centers for Medicare & Medicaid Services (CMS) released a summary of 2017 quality withhold results for Cal MediConnect plans. The report shows both California state-specific and CMS Core withhold measure benchmarks that Cal MediConnect (CMC) plans met or did not meet.

Background

Cal MediConnect, part of California’s Coordinated Care Initiative, is one of ten states partnering with CMS in the national demonstration called the Financial Alignment Initiative (FAI). The initiative seeks to better serve people who are dually eligible for Medicare and Medicaid by testing person-centered, integrated care models. To ensure high quality care and encourage quality improvement, both CMS and the Department of Health Care Services withheld 3 percent of the Medicare and Medicaid components of the capitation rate paid to each CMC plan. The CMC plans are eligible for repayment of the withheld amounts subject to their performance on a combination of CMS Core and California-Specific quality withhold measures. Examples of quality withhold measures include:

  • Annual flu vaccination rates
  • Controlling blood pressure
  • Interactions with the care team

The Department of Health Care Services publishes a quarterly Cal MediConnect Performance Dashboard. The dashboard provides select data on measures on key aspects of the CMC program, including quality withhold results.

Results

On average, Cal MediConnect plans met 75 percent of all withhold measures – 83 percent of CMS Core measures and 63 percent of California state-specific measures. On average, plans collected 98 percent of their withhold amounts. Due to the wildfires in California, seven plans received 100 percent of the withheld amount based on an adjustment for plans affected by extreme and uncontrollable circumstances.

For more information on the national demonstration, visit the FAI Spotlight and Releases page

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