Plan Performance Report Overview

The Plan Performance Report is a publicly available report that consolidates performance measures for Covered California health plans and population-level metrics for Covered California members. Built from multiple data sources, the report evaluates health plan performance across three key areas: disparities reduction, cost reduction, and quality improvement. As part of its commitment to holding insurers accountable, Covered California requires health plans to submit data demonstrating their compliance with contractual requirements and their ability to deliver timely, high-quality care to members. This report serves to publicly display the results of these evaluations, ensuring transparency and accountability in addressing disparities, reducing costs, and improving care quality.

The 2025 report is the fourth Plan Performance Report, covering measures from plan years 2020–2024. Some measures may include additional years for trend analysis or fewer due to data quality limitations. Measure results are released on a rolling basis as finalized.

The 2025 Plan Performance Report is organized by data source: Healthcare Evidence Initiative (HEI), Quality Rating System (QRS), and Plan Reported Performance.

• Healthcare Evidence Initiative (HEI): Health and dental plans submit claims/utilization data to HEI to inform purchasing strategies and broader policy initiatives.
• Quality Rating System (QRS): Plans submit data to CMS, which evaluates clinical quality, enrollee experience, and efficiency to assist consumers and encourage improvement.
• Contract Requirements: Plans report compliance with obligations regarding quality, network management, delivery systems, and improvement strategies.

Measure results from each of these data sources are grouped by domains:

• Behavioral Health
• Preventive Care
• Utilization
• Dental Health
• Cost & Affordability

• Behavioral Health
• Population Health
• Delivery System & Payment Strategies
• Dental Health
• Quality Transformation Initiative (QTI)
• Removal from Exchange Program (QHP Issuer IND Model Contract)

• Accreditation
• Delivery System & Payment Strategies
• Cost & Affordability

Covered California ensures that all publicly displayed measure results meet the following criteria:

• Validity, reliability, and completeness of the data.
• Plan-specific reporting is provided when data is non-proprietary, adds value, and allows for methodologically sound comparisons.
• Proper citation of data sources and documentation for non-standard measures.
• Year-over-year trending is determined by the relevant measure stewards for standard measures.