L.A. Care is committed to quality. This leads us to create programs and services to meet the needs of our members and providers. L.A. Care wants to make sure you are getting the best health care. This is called Quality Improvement. Each year the quality improvement and health equity program looks at care, safety, and the services you get. This tells us what we are doing well or may need to change. This is also a way to measure our progress toward ensuring you get the best health care. Quality Improvement helps you get better and/or stay healthy by helping you get needed tests, shots, and care for diseases such as asthma, heart disease, and diabetes. You can see some of our results in the links provided.
Here are some of our efforts to make sure you get the best health care:
- Our goal is to do better
- We track the health care services that you get through a survey of our doctors called Healthcare Effectiveness Data and Information Set (HEDIS®)
- We ask how well we serve you through a member survey every year called Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
Each year, we make changes to improve equity and the health care you get by starting new projects.
If you have any questions about the health plan, call L.A. Care's Member Service Department.
If you want a paper copy of this notice, please email the Quality Improvement Department of L.A. Care.
Some of the things we measure include:
- Appointment availability
- After-hours services
- How long do patients wait in the office for an appointment
- Facility site review, which includes looking at access for disabled people
- Making sure the network of doctors in your area fits your needs
- Member satisfaction
- Doctor satisfaction
- Quality of care studies to ensure appropriate:
- Well child visits
- Immunizations
- Cervical cancer screening
- Breast cancer screening
- Diabetes care
- Asthma care
- High blood pressure
- Prenatal and postpartum care
- Cholesterol management
The Quality Improvement Goals are:
- Improve the quality of care
- Improve Health Equity
- Improve the delivery of care for persons with complex healthcare needs
- Improve member satisfaction
- Meet regulatory and other health plan requirements
- Monitor and improve patient safety
- Monitor and improve behavioral healthcare
- Monitor quality of care in Long Term Care Nursing Facilities and Community Based Adult Services (CBAS) Facilities
- Provide Health Education Programs, Services and Resources
- Provide culturally linguistically appropriate services
- Provide a network of high-quality providers and practitioners
- Provide an evidence-based model of care
- Provide Continuous Improvement of Quality of Care Model of Care (MOC)
Providing an effective, system-wide, measurable plan for monitoring, evaluating and improving the equity and quality of care and services:
National Committee for Quality Assurance (NCQA)
L.A. Care has achieved NCQA Health Plan (HP) Accreditation since 2014. Most recently, in 2020, L.A. Care earned this accreditation for its Medi-Cal, Medicare Plus (Dual-Special Needs Plan [D-SNP]) and L.A. Care Covered (LACC) lines of business.
Additionally, L.A. Care earned the 2021 NCQA Multicultural Health Care Distinction (MHC), this is L.A. Care's 5th consecutive Distinction; it was first awarded in 2013 and has since successfully earned this distinction every two years.
For these awards, NCQA evaluated L.A. Care's work to reduce health care disparities, network adequacy, and consumer protection, the organization's ability to collect Race/Ethnicity/Language (REL) data, and provide language assistance to members.
Earning the Health Plan Accreditation (HP) and the Multicultural Health Care Distinction (MHC) from NCQA is important for L.A. Care as it demonstrates L.A Care's commitment to quality improvement translates to optimum levels of health services to our members while also tailoring these services to our members' cultural and linguistic preferences.
We use several tools each year to help us determine how we are doing. These include the Healthcare Effectiveness Data and Information Set (HEDIS®) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey.
These measure the quality of care and services and show us where to focus. HEDIS measures the quality of many types of care and service, and is used by nearly all American health plans. CAHPS is a survey that measures how happy members are with their doctors, care, and health plan. We use these results to help us better our service.
HEDIS Summary Report - Medicaid
HEDIS Summary Report - L.A. Care Covered™
HEDIS Summary Report - Duel Eligible Special Needs Plan
L.A. Care takes your concerns seriously. We want to give you and your family the best care and services.
CAHPS Member Satisfaction Survey (Child) - Medicaid
CAHPS Member Satisfaction Survey (Adult) - Medicaid
CAHPS Member Satisfaction Survey - Cal MediConnect
CAHPS Member Satisfaction Survey - L.A. Care Covered
Star ratings compare Medicare Advantage and Prescription Drug Plans to help you make informed choices about your health care. Ratings focus on patient care and satisfaction, using national clinical and service-quality measures, health outcomes, and patient feedback.
We offer free help from a nurse, day or night. The nurse will answer your health care questions so you can care for yourself or your family. Get more information about the 24-hour nurse advice line.
L.A. Care uses guidelines to make sure that its members have access to care: