Calidad del Cuidado

The Care-Based Incentive (CBI) program offers financial incentives and technical assistance to primary care providers (PCPs) to support them in helping members manage their own care and reduce health care costs. Visit our Care-Based Incentive page for information about the CBI program.

The California Department of Healthcare Services (DHCS) requires primary care providers (PCPs) to administer regular health assessments. Refer to the Health Assessments page for primary care resources and details on which health assessments are required, including:

Initial Health Assessment

• PCPs must complete an IHA for new Alliance members within 120 days of enrollment.

Staying Healthy Assessment

• PCPs must administer a SHA for new members within 120 days of enrollment and again at defined age intervals.

Unhealthy Alcohol Screening and Behavioral Counseling

• Steps to take when a member is identified as having a potential alcohol misuse problem.

Healthcare Effectiveness Data and Information Set (HEDIS) is a performance measurement tool used by U.S. health plans to measure effectiveness, availability and experience of care. Our HEDIS page includes information on the following topics.

• Purpose of HEDIS, the annual HEDIS audit and the audit timeline.
• Explanation of data collection.
• How protected health information is handled.
• Audit results and list of past award recipients.
• HEDIS tip sheets, reports, tools and reference guides.

Visite la Immunization Resources page for immunization resources to keep members educated about the importance and benefits of immunizations throughout their life. Resources include:

• COVID-19 vaccine resources.
• Information on how to access member immunization data.
• Immunization schedules from birth to adult age.
• Required immunization registry websites for Santa Cruz, Monterey and Merced counties.
• General and county immunization resources.
• Printable immunization materials in English, Spanish and Hmong for members of all ages.

The Alliance encourages members to receive routine care through rewards raffles when they participate in certain health education and disease management programs or meet certain health care thresholds. Learn more about how we help members stay healthy and how providers can refer members to any of our programs on our Member Incentives page.

Site reviews ensure that all provider sites meet the state’s prescribed stands of care. The Site Reviews page provides information on the different types of site reviews, the evaluation process, survey tools and standards for each site review and helpful resources. Types of site reviews covered:

Facility Site Review

• Physical assessment of a primary care practice site.

Medical Record Review

• Evaluation of a member’s record.

Physical Accessibility Review

• Physical evaluation of a service site that provides care to Medi-Cal members who are seniors and/or person with disabilities.

Visite nuestra Incentivos Basados en el Valor page for information on provider incentive payments for meeting specific measures of care for certain high-cost or high-need populations. Metrics target areas such as:

• Behavioral health integration.
• Chronic disease management.
• Prenatal/post-partum care.
• Early childhood prevention.