The Californer - Gold Coast Health Plan Among State's Top Performers for Outstanding Health Care Quality

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Ventura County's local Medi-Cal plan achieves excellence across care measures for members

CAMARILLO, Calif. - Californer -- Gold Coast Health Plan (GCHP) connected more Medi-Cal members with vital health care screenings and immunizations in 2023, surpassing regulatory health care quality metrics and ranking it as one of only four managed care plans in the state to meet required performance levels.

The state Department of Health Care Services (DHCS), the agency that oversees the Medi-Cal program, requires managed care plans like GCHP to report annually on a set of health care quality performance measures known as the Managed Care Accountability Set (MCAS). Health plans are evaluated in 18 measures in four key health categories: children's health, reproductive health and cancer prevention, chronic disease management, and behavioral health.

At the end of 2023, GCHP exceeded the minimum performance level (MPL) – or the 50th percentile nationally-established benchmark – on nearly 94% of the measures – achieved through an extraordinary system-wide effort that resulted in the closure of nearly 40,000 more care gaps than the previous year. GCHP achieved or exceeded the MPL for all eight children's health measures, joining a small group of four health plans to reach this milestone. In Ventura County, this effort resulted in:

Nearly 5,000 more children 3-21 years of age completing an annual well-care visit.
More than 200 more adolescents completing all vaccines recommended by the American Academy of Pediatrics.

In the category of reproductive health and cancer prevention, GCHP ranked among 14 health plans statewide to meet or exceed the standard DHCS set for the five quality measures. In Ventura County:

More than 3,400 more women received a cervical cancer screening.
More than 900 more women were screened for chlamydia.
About 440 more women got mammograms.

"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," said Dr. Felix Nuñez, GCHP's acting chief executive officer (CEO). "We are especially pleased with our success in children's health and cancer prevention, two areas critical to long-term wellness. As we move forward, we remain focused on building on our provider partnerships for continuous improvement across all areas of care."

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Since 2023, GCHP has implemented various quality improvement initiatives, including a $50-million provider incentive program aimed at integrating the operations and data sharing necessary between providers and GCHP to ensure that members receive timely, reliable, and comprehensive care. GCHP provided an additional $767,000 in incentives for members who completed recommended preventive care.

"This achievement is a testament to the power of collaboration," said Laura Espinosa, chair of the Ventura County Medi-Cal Managed Care Commission, which governs GCHP. "By working together, the GCHP team and its dedicated providers and community partners were able to make significant strides in improving access to care, promoting the importance of wellness, and ultimately ensuring better outcomes for Medi-Cal members in our community. The GCHP Team has our unwavering support as it works to build on this momentum."

For 2024 and 2025, GCHP has continued to enhance its quality initiatives with a focus on collaboration and innovation to boost health care quality performance in the areas of asthma care and behavioral health, and start building capabilities for new quality measures, along with an ongoing investment in members by distributing $1.7 million in member incentives in 2024.

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

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About Gold Coast Health Plan
Gold Coast Health Plan proudly serves nearly 245,000 Medi-Cal members in Ventura County through its network of primary care physicians, specialists, behavioral health providers and hospitals. Since it was founded in 2011, Gold Coast Health Plan has been committed to providing access to high-quality care and improving the health of its members, which include 1 in 3 county residents, 1 in 6 seniors, and 1 in 2 children up to the age of 5. To learn more, visit: www.goldcoasthealthplan.org.