L.A. Care Receives 4-Star NCQA Health Plan Rating

The largest publicly-operated health plan in the country now has the highest Medi-Cal managed care NCQA star rating in Los Angeles County

LOS ANGELES — L.A. Care Health Plan, the largest publicly-operated health plan in the country, is proud to announce that its new National Committee for Quality Assurance (NCQA) rating makes it the highest rated Medi-Cal managed care plan in Los Angeles County. NCQA works to improve health care quality through assessment of evidence-based standards, measures, and programs, and assignment of accreditation status.  

L.A. Care's rating jumped from 3.5 to 4 stars for 2019-2020. The Quality Improvement team at L.A. Care attributes the rise to a number of member and provider campaigns designed to increase access to care, utilization of services and member satisfaction.

"There is no silver bullet when it comes to improving quality. You have to tackle the job from all angles," said Richard Seidman, MD, MPH, L.A. Care Chief Medical Officer. "We have implemented a variety of interventions to support our members and providers and also ensure we are providing easy access to care."

The interventions include, but are not limited to, a webinar series offering provider education on quality improvement issues, including hot topics like talking to patients about vaccination hesitancy, and annual calls to members reminding them of various cancer screenings and wellness visits for children. We also use educational social media posts and targeted providers receive emails with Patient Satisfaction Tips of the Week. 

"Ultimately, all of these interventions aim to improve the quality of care that our members are receiving," said James Kyle, MD, L.A. Care Medical Director for Quality Improvement. "We have to be responsive to the changing needs of our members and providers to ensure healthy outcomes for the people we serve."

L.A. Care also uses pay-for-performance incentive programs to amplify the various interventions, making a business case to providers for quality improvement. The programs are a way to communicate L.A. Care's quality improvement priorities and measure provider performance leading to bonus revenue. On average, providers earn about a 10% bonus, and upwards of a 30% bonus for the highest performers.

The health plan rating is based on the combined scores from Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Health Plans Study (CAHPS) survey, and NCQA’s Accreditation standards. HEDIS data is collected through a combination of surveys, provider medical record audits and insurance claims data. The CAHPS member survey consists of approximately 70 questions and measures the satisfaction of members with the health plan, provider accessibility, the patient/provider relationship and communication.