Today, the Department of Health Care Services (DHCS) is releasing new data on Health Risk Assessment (HRA) completion rates in the Cal MediConnect program. You can find the new Cal MediConnect HRA Dashboard and more information about HRAs here. Starting with this release, a new dashboard will be available quarterly.
Cal MediConnect HRA Dashboard
Earlier this year, DHCS released an initial HRA dashboard with data from April to September 2014. At that time, the Cal MediConnect health plans were reporting data in different ways, making it difficult to understand individual health plan performance or compare across plans. Since that initial dashboard was released, DHCS and the Centers for Medicare and Medicaid Services (CMS) have worked with the Cal MediConnect health plans to clarify reporting requirements and standardize definitions. All Cal MediConnect health plans resubmitted data for April to September 2014, and that revised data is reflected as part of this dashboard. The previous dashboard should no longer be used to understand plan performance.
The data shows that from April 2014 through March 2015, Cal MediConnect health plans completed 89 percent of HRAs within 90 days of enrollment for beneficiaries who took part in the HRA process and could be reached by the health plan. The data also showed that 35 percent of beneficiaries were unreachable, and 10 percent of beneficiaries were unwilling to participate.
DHCS, CMS, and the Cal MediConnect health plans are working together to share best practices and improve the health plans’ ability to reach their beneficiaries in order to complete the HRA process. For example, health plans are partnering with other providers, such as pharmacies, that may have more up-to-date contact information for beneficiaries.
Cal MediConnect HRAs
An HRA is a survey tool that assesses the full range of a beneficiary’s needs, such as medical and behavioral health, chronic conditions, and disabilities. A beneficiary’s HRA serves as the foundation of an individualized care plan and helps the Cal MediConnect health plan connect a beneficiary to the care and services they need. Cal MediConnect health plans are required to conduct the HRA within 45 days for beneficiaries that are identified as high-risk, and 90 days for low-risk beneficiaries (see Duals Plan Letter 15-005 for additional information).
As part of ongoing quality-monitoring efforts, DHCS and CMS work with Cal MediConnect health plans to track completion rates. Because of the important role that the HRA plays in providing quick, timely, and appropriate care for the beneficiary, the HRA completion rate has been established as a “quality withhold” measure for Cal MediConnect. This means that a portion of each health plan’s capitation payment is withheld from payment, and if the health plan meets the required threshold for this measure, the health plan can earn back the withheld payment.
Thank you for your continued interest in the Cal MediConnect program. If you have any questions, please e-mail info@calduals.org.
