hedis aggregated quality factor score (aqfs)...dhhs primary health medi-cal managed care advisory...

DHHS Primary Health

Medi-Cal Managed Care Advisory Committee

February 27, 2017

HEDIS

Aggregated Quality Factor Score (AQFS)

Health Plan

Report Year 2015-2016

Change 2013 2014 2015 2016

Minimum Performance Level 40% 40% 40% 40%

Statewide Weighted Average 60% 58% 60% 60%

Anthem Blue Cross 41% 40% 43% 46% +3%

Health Net 49% 45% 50% 46% 4%

Molina 42% 41% 42% 53% +11%

Kaiser 97% 97% 97% 96% 1%

The AQFS is a single score that accounts for plan performance on all DHCS-selected Health

Effectiveness Data and Information Set (HEDIS) indicators.

Report Year data is based on the prior year’s services.

Statewide Average Plan Performance: 60%, based on weighted average.

Minimum Performance Level: 40%.

High Performance Level: 100%.

Median score: 53%.

Range: 32% (Health Net San Joaquin) to 97% (Kaiser San Diego).

Number of Health Plans: 53 (up from 44 in 2015, due to expansion into rural counties).

Five Plans are below the Minimum Performance Level:

o Centene operating as Health Net – San Joaquin – 32%

o Centene operating as California Health & Wellness – Region 1 – 38%

o Centene operating as California Health & Wellness – Region 2 – 38%

o Anthem Blue Cross – San Benito – 38%

o Health Plan of San Joaquin – San Joaquin – 39%

Source: DHCS Medi-Cal Managed Care Performance Dashboard