Report 2022-502 Recommendation 4 Responses

Report 2022-502: Follow-Up: Children in Medi‑Cal: The Department of Health Care Services Is Still Not Doing Enough to Ensure That Children in Medi‑Cal Receive Preventive Health Services (Release Date: September 2022)

Recommendation #4 To: Health Care Services, Department of

To mitigate health disparities for children of differing ethnic backgrounds and language needs, DHCS should revise the methodology for its external reviewer's health disparity study to enable it to better make demographic comparisons, and it should use the findings to drive targeted interventions within health plan service areas. It should publish this study annually.

Annual Follow-Up Agency Response From December 2023

The annual Health Disparities Report was published for Measurement Year (MY) 2021 data, and the data report for MY 2022 is under development. Additionally, DHCS received audited, stratified quality measures by race and ethnicity, which will be used for targeted goal setting. MCPs have started disparity-focused clinical performance improvement projects for well-infant visit quality measures. Lastly, DHCS is collaborating and aligning disparity targets across other state programs. The latest Health Disparities Report can be found here. The conclusions and findings of the report are being addressed through the priority areas as laid out in the Comprehensive Quality Strategy report. Additionally, DHCS requires a health equity focused performance improvement project geared toward EQRO report findings, can be found here on page 98.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

DHCS did not provide evidence to substantiate that it had fully implemented this recommendation.

1-Year Agency Response

The annual Health disparities report was published for MY 2021 data, and the MY 2022 data-based report in under development. Additionally, DHCS received audited stratified quality measures by race/ethnicity, which will be used for targeted goal setting. MCPs have started their disparity focused clinical performance improvement projects for well-infant visit quality measures. Lastly, the DHCS is collaborating and aligning disparity targets across other state programs.

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

DHCS did not provide evidence to substantiate that it had fully implemented this recommendation.

6-Month Agency Response

DHCS is in the final process of completing the health disparities report in collaboration with the EQRO. Additionally, DHCS is actively working across state programs (California Department of Public Health, Department of Managed Health Care, and the California Health and Human Services Agency) in addressing health disparities for targeted measures (immunization, maternal care, and behavioral health); which is currently underway. Additionally, DHCS is working with MCPs on aligning the performance improvement project with a disparity focus for well-infant visits which began in January 2023. DHCS is also in the process of gathering plan calculated HEDIS rates stratified by Race/Ethnicity and should have the rates by July 2023. With the information, DHCS can hold plans accountable to rates with large evident disparity gaps and focus QI on the lower rates. The Estimated Implementation Date has been extended due to efforts of capturing performance measure rates by Race/Ethnicity in July.

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

Per DHCS's response, it will not implement this recommendation until August 2023.

60-Day Agency Response

DHCS continues to update the report and has begun the process of including a more robust demographic analyses spanning broader than racial/ethnicity categorizations and develop targeted approaches to address disparities evident in the report. The upcoming report will include a geographical comparison for DHCS to analyze and make programmatic changes to health equity improvement efforts. Additionally, the upcoming 2021-2022 health disparities reports will include Healthy Places Index (HPI) analysis, which will be used throughout DHCS's QI work and will be de-aggregated down to the plan level so that they can incorporate the information within their strategies to mitigate disparities. DHCS will continue to work with the EQRO incorporating the CSA recommendations for the new Health Disparities Report for 2022-2023, which will include efforts to broaden the racial/ethnic MCP reporting to align with National Committee for Quality Assurance (NCQA) reporting.

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

Per DHCS's response, it will not implement this recommendation until January 2023.

All Recommendations in 2022-502

Agency responses received are posted verbatim.