Gold Coast Health Plan Excels in Health Care Quality in California's Medi-Cal System

Gold Coast Health Plan (GCHP) has made a remarkable impact within California's Medi-Cal program, achieving top-tier performance in health care quality metrics for the year 2023. This local health plan surpassed regulatory benchmarks, connecting more Medi-Cal members to crucial health services such as screenings and immunizations than ever before.

Located in Ventura County, GCHP stands out as one of the rare plans in the state recognized for its commitment to excellence across a range of health care measures. According to the California Department of Health Care Services (DHCS), which oversees the Medi-Cal program, health plans are measured against the Managed Care Accountability Set (MCAS). This set outlines 18 specific performance measures categorized primarily into four vital areas: children's health, reproductive health and cancer prevention, chronic disease management, and behavioral health.

By the end of 2023, GCHP outperformed the minimum performance level (MPL), achieving at least the 50th percentile of nationally recognized benchmarks in almost 94% of these measures. This significant leap can be attributed to strategic system-wide efforts, leading to the closure of approximately 40,000 more care gaps compared to the previous year. Notably, GCHP attained or surpassed the MPL for all eight assessed measures within children's health, setting itself apart as one of only four health plans to achieve this milestone.

In quantitative terms, this performance translates to nearly 5,000 additional children between the ages of 3 and 21 completing annual well-care visits, and more than 200 adolescents successfully receiving all vaccines recommended by the American Academy of Pediatrics.

When examining reproductive health and cancer prevention metrics, GCHP excels further, having achieved recognition among 14 health plans in the state. This resulted in more than 3,400 women receiving cervical cancer screenings and over 900 being screened for chlamydia. Additionally, around 440 women had mammograms performed, reinforcing GCHP's dedication to women's health.

Dr. Felix Nuñez, acting CEO of GCHP, commented on the outstanding results, stating, "Our strong results in this year's health care quality metrics reflect the dedication of our providers and our staff to connect our members with high-quality care that will lead to early interventions and improved health outcomes. We are especially pleased with our success in children's health and cancer prevention, two areas critical to long-term wellness."

GCHP's journey towards enhancing health care quality has been marked by various quality improvement initiatives, including a $50 million provider incentive program designed to strengthen collaboration and data sharing between GCHP and its providers. Additionally, the plan invested $767,000 to incentivize members who completed recommended preventive care procedures.

Laura Espinosa, chair of the Ventura County Medi-Cal Managed Care Commission, applauded GCHP's accomplishments, emphasizing the importance of teamwork in improving access to care and promoting wellness. "This achievement is a testament to the power of collaboration," she noted, reiterating the essential role of community partners in fostering better health outcomes for Medi-Cal members.

Looking forward, GCHP is poised to continue enhancing its quality initiatives throughout 2024 and 2025. The organization emphasizes collaboration and innovation as key components in boosting health care quality, particularly in asthma management and behavioral health. GCHP plans to introduce new quality measures while investing an additional $1.7 million in member incentives.

Dr. Nuñez expressed optimism for the future, stating, "Our health care system in Ventura County is well-positioned today to deliver even better results in the future."

Established in 2011, Gold Coast Health Plan serves nearly 245,000 Medi-Cal members in Ventura County, partnering with primary care physicians, specialists, behavioral health providers, and hospitals to provide comprehensive health services. One in three county residents relies on this plan, highlighting its significant role in the local health ecosystem.

To learn more about Gold Coast Health Plan and its initiatives, visit Gold Coast Health Plan Website.