Central California Alliance for Health Awards Santa Cruz County Physicians & Clinics for Efforts to

The Alliance was recognized by the California Department of Health Care in October as a Top-Performing Medi-Cal Managed Care Plan
By: Central California Alliance for Health
SANTA CRUZ, Calif. - Jan. 23, 2019 - PRLog -- One in four residents in Santa Cruz County receive their health care coverage through the Central California Alliance for Health (the Alliance). The Alliance is a not-for-profit, Medi-Cal health plan for Santa Cruz, Monterey and Merced counties, and nearly 84,000 of its 350,000 members receive coverage through the Affordable Care Act.

Thanks to collaborations between the Alliance, physicians and medical centers in its network, and the communities it serves, the Alliance was recognized as one of the state's "Overall Most Improved" Medi-Cal managed care plans in October by the California Department of Health Care Services (DHCS). From a field of 53 regions in California, the Alliance in Santa Cruz and Monterey Counties rose to become one of the top five regions in the state—ranking fourth in the state from 14th in the state the year before—based on HEDIS® (Healthcare Effectiveness Data and Information Set) ratings.

The Alliance scored in the 90th percentile in ten measures in California from the DHCS—signifying "High Performance" status in diabetes care, screening for cervical cancer, childhood and adolescent immunizations, prenatal and postpartum care, well-child visits, and decreased antibiotic use, among several other HEDIS measures. HEDIS, which is developed and maintained by the National Committee for Quality Assurance (NCQA), is the most widely recognized health plan assessment program in the nation.

"These health measures indicate people are coming in early for care and getting access to care at the right time," said Dr. Dale Bishop, Chief Medical Officer at the Alliance. "That means patients are healthier and the overall cost of care is down. Most importantly, our community is healthier."

Bishop noted that the Affordable Care Act enabled a significant portion of Santa Cruz's population—not previously insured at all—to get coverage through the Alliance. "Take cervical cancer, for example; with early detection, patients who would not otherwise have been insured are able to avoid the costly and complex treatments that might have been needed if the cancer were to have progressed."

The Alliance contracts with 90 percent of all primary care physicians in Santa Cruz County. Through close partnerships, the Alliance works to educate its local care providers on up-to-the-minute best practices. "It really is a hands-on approach," said Michelle Stott, RN, Quality Improvement Director at the Alliance.

Incentives for doctors and clinics are provided by the Alliance to inspire the pursuit of NCQA health goals—as well as webinars, in-person site visits and extensive outreach. Providing subject-matter experts to clinics; collecting data on low-performance clinics; grant funding; and providing practice coaching and quality improvement staff so clinics can improve are just some of the Alliance's many improvement tools.

Alliance Honors Its 2018 Health Care Network for High Performance

To acknowledge providers in its network for their partnership and performance on HEDIS measures, the Alliance last year launched its own recognition program, presenting top physicians and clinics in the county with its own Gold, Silver and Bronze Quality Awards—based on the number of Alliance members each clinic serves.

Dori Rose Inda is CEO at Salud Para La Gente (Salud), which won the Silver Quality Award from the Alliance, in the category of 1,000 plus Alliance patients. "This award shows our ability to affect our patients every day in a way that really improves their health," she said, "That's really what this award is about, measuring that people are healthier because of the care we are giving."

Salud ranked high in improvements for diabetes care, immunizations, prenatal care and nutritional counseling during well-child visits.

"What's exciting for me," Chief Medical Officer at Salud Amy McEntee said, "is that these categories are about prevention. That's going to help everyone in the long run. And diabetes care is crucial. That's a hard measure to move, and it takes a whole team to move it."

This year's HEDIS scores reflect a record high performance for the Alliance and its provider network.  "What these scores mean to me," Stott said, "is that Medi-Cal health plans can achieve high-performance national benchmarks and assurance of excellent care delivery for our members."

Santa Cruz County Alliance Health Care Quality Awards Winners:

(100-1,000 Medi-Cal Members)

·         Gold Quality Award: Dr. Josefa Simkin, Freedom

·         Silver Quality Award: Palo Alto Medical Foundation, Aptos

·         Bronze Quality Award: Dr. Robert Weber, Watsonville

(1000+ Medi-Cal Members)

·         Gold Quality Award: Plazita Medical Clinic, Watsonville

·         Silver Quality Award: Salud Para La Gente, Watsonville

·         Bronze Quality Award: City of Santa Cruz Watsonville Health Center, Watsonville

90th Percentile Award, Pediatric Clinics

·         Pediatric Medical Group, Freedom

·         Dr. Madhu Raghavan, Watsonville

About the Alliance: Central California Alliance for Health, the Alliance, established in 1996, serves approximately 350,000 members in Santa Cruz, Monterey and Merced counties. Using the state's County Organized Health System (COHS) model, the Alliance delivers innovative community-based health care services with the goal to improve medical outcomes and cost savings. The award-winning plan employs nearly 600 staff members in the three counties and manages a budget of $1.1 billion. The Alliance prides itself on its close partnership with contracted providers to promote prevention, early detection and effective treatment, and overall to improve access to quality health care for its members.

About the NCQA: NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA's website (http://www.ncqa.org/) contains information to help consumers, employers and others make more informed health care choices.

About HEDIS: HEDIS is the measurement tool used by the nation's health plans to evaluate their performance in terms of clinical quality and customer service. HEDIS is a registered trademark: National Committee for Quality Assurance.

Eric McKeeby, Communications Director
Central California Alliance for Health
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Location:Santa Cruz - California - United States
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