CalOptima Ranked Top Medi-Cal Plan in California
National Committee for Quality Assurance (NCQA) honor recognizes CalOptima’s overall quality of care for more than 600,000 Orange County residents
ORANGE, Calif. (September 18, 2014) — CalOptima is California’s top-ranked Medi-Cal health plan, according to the NCQA’s Medicaid Health Insurance Plan Rankings 2014–2015.
CalOptima is 1st in the state and 29th nationwide among the 136 Medicaid plans that were ranked. The NCQA rankings are based on standardized, third-party-audited data regarding health care quality and customer satisfaction, as well as NCQA accreditation scores. CalOptima’s ranking is due to a Board of Directors and executive leadership decision last year to collect and share the full set of NCQA measures so nationwide comparison would be possible in 2014.
“CalOptima’s commitment to quality for our members is reflected
in the NCQA recognition,” said Mark Refowitz, Chairman of the
CalOptima Board of Directors. “Our ranking is confirmation that
Orange County’s most vulnerable residents are healthier because
of CalOptima and our provider partners. We share this honor with
the thousands of dedicated doctors, health care providers,
hospitals and other facilities that deliver care to our members
CalOptima CEO Michael Schrader said that the 2014–2015 NCQA rankings of Medicaid plans come at an important time of expanded access to such plans for low-income people across the nation. In Orange County through CalOptima, nearly 200,000 people have gained health coverage since January 2014, he said. “Our new members can rely on CalOptima and feel confident that the care they receive is among the best in the state,” Schrader said. “CalOptima is a mission-driven organization focused on providing all members with access to quality health care delivered in a cost-effective and compassionate manner. The NCQA ranking affirms that we are truly living our mission.”
NCQA assesses plan quality based on 46 clinical measures related
to both preventive care and treatments. Preventive measures
report whether members are getting services to keep them healthy,
such as well-child visits, immunizations, nutrition counseling
and breast cancer screenings. Treatment measures gauge whether
members are receiving appropriate care and medications in
response to acute illnesses and chronic diseases, including
diabetes and high blood pressure. NCQA also evaluates plan
quality based on 11 customer satisfaction dimensions, such as
getting care quickly and how well doctors communicate. Further,
CalOptima is NCQA
accredited with “commendable” status through 2015, which also contributes to the agency’s new high ranking in California.
Orange County Supervisor and CalOptima Board Member Janet Nguyen, whose supervisorial district has the highest concentration of Medi-Cal members in the county, said: “All of the efforts we have engaged in are paying off, resulting in better services for members. I am proud of our staff, nurses and doctors for the fine work they have done to earn CalOptima the distinction of being the top-ranked Medi-Cal plan in California.”
CalOptima is nearing its 20th anniversary, with the first members served in October 1995. Founding Board Member Peter Anderson, M.D., an emergency physician in Fountain Valley, sees the NCQA ranking as reward for the efforts invested by the community at the beginning and still today. “CalOptima was founded in response to difficulties in providing local Medi-Cal members with consistent access to quality care,” Dr. Anderson said. “The NCQA ranking proves that CalOptima has more than met that challenge. It has risen to new heights in serving our community. I congratulate all the CalOptima team members for achieving this lofty goal.”
A county organized health system, CalOptima provides publicly funded health care coverage for low-income children, adults, seniors and people with disabilities in Orange County, Calif. CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner. In total, CalOptima serves more than 600,000 members with a network of more than 6,600 primary care doctors and specialists, as well as 30 hospitals. Learn more about CalOptima in this video here.
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. Learn more about the NCQA rankings here.