Staff Report

CenCal Health, the publicly sponsored health plan for Medi-Cal in Santa Barbara and San Luis Obispo counties, has received top marks among the state’s 56 Medi-Cal plans for timeliness of prenatal care, and timeliness of postpartum care, according to the Healthcare Effectiveness Data and Information Set (HEDIS) 2020 results.

Santa Barbara County earned the No. 1 spot, while San Luis Obispo County came in second place statewide. Additionally, both counties rated in the top 5% nationally among all Medicaid plans in these same two categories.

Ensuring timely medical visits for women during and after pregnancy means better management of health conditions that may complicate their gestational and postpartum periods. It also reduces the risk of poor health outcomes for babies. In 2019, within the health plan’s network, there were 1,623 deliveries in Santa Barbara County and 613 deliveries in San Luis Obispo County.

CenCal Health utilizes HEDIS (one of the most widely accepted performance measurement tools among managed care plans) to objectively evaluate the quality of care delivered to its members.

CenCal Health then identifies whether barriers exist that may have prevented the delivery of appropriate or timely care. If barriers are identified, interventions are implemented to ensure that health plan members have future access to high-quality care.

“Timely and complete obstetrical care is one of the most important commitments a woman can make to have a healthy pregnancy, and give her baby a healthy start to life,” said Carlos Hernandez, CenCal Health Quality Measurement director.

“For those reasons, CenCal Health is tremendously proud of the top statewide prenatal and postpartum care ratings achieved by its providers, and their achievements affirm our health plan’s longstanding pursuit of performance excellence,” he said.

The health plan’s Santa Barbara County region also garnered high HEDIS scores — rating in the top 5% of Medicaid plans nationally — for diabetes management for hemoglobin A1C levels, and immunizations for adolescents (meningococcal, Tdap, and HPV series).

Additionally, both counties’ ratings exceed the national 90th percentile in two Quality of Care categories: Childhood immunizations (including DTap, polio, pneumococcal and influenza) and weight assessment (body mass index percentile) for children and adolescents.

While these high scores offer a positive look at CenCal Health’s Quality of Care measures, the health plan will continue to prioritize immunizations and ongoing preventive visits, as utilization rates for these areas of care have recently plummeted in California by 40% due to patients’ fears of COVID-19 contagion, according to the California Department of Public Health.

“CenCal Health’s providers once again have shown strong results across the quality measurement spectrum,” said Bob Freeman, CenCal Health CEO.

“What’s particularly impressive is the fact that while other areas of the state have seen immunization rates decrease due to the COVID-19 pandemic, CenCal Health’s provider immunization rates remain robust and among the highest in the state,” he said. “These high quality of care measurements speak for themselves in relation to CenCal Health’s provider network.”

Detailed performance results for the health plan are available on CenCal Health’s website.