2021 Health Plan Performance Report
About the Report
Covered California is committed to holding insurers accountable for ensuring that people get the right care at the right time. Through its annual contract requirements, Covered California requires every health insurance issuer that sell plans through the Exchange to submit data on how their plans perform every year. This report, the Plan Performance Report, will publicly display the information Covered California requires plans to submit when that data relates to disparities reduction, cost reduction or quality improvement.
2021 is the first year the Plan Performance Report is being published and includes measures from 2017 through 2019. Measures released each year will be available on a rolling basis as they are finalized. All measures here have met Covered California’s criteria for public reporting, including:
- All data has been assessed for validity, reliability, and completeness
- All data is displayed as plan-specific whenever the data is not proprietary, plan-level reporting would add value, and plan performance comparisons are methodologically sound
- Data sources are cited (see Sources of Data here) and non-standard measures are documented
- Covered California will defer to the applicable measure stewards to determine when year-over-year trending is appropriate for standard measures
Equity & Disparities Reduction
Edit EDR Plan Performance on Contract Requirements Plan Performance on Contract RequirementsMeasure Results in this Section (all measures listed alphabetically)
- NCQA Multicultural Distinction
- Race and Ethnicity Self-Reporting
- (none)
Measure Results in this Section (all measures listed alphabetically)
- Adult Preventative Visits
- Ambulatory Emergency Room Visits
- Breast Cancer Screening
- Diabetes Hemoglobin A1c Testing
- Proportion of Days Covered: Diabetes All Class
- Proportion of Days Covered: RAS Antagonists
- Proportion of Days Covered: Statins
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Behavioral Health
Edit BH Plan Performance on Contract Requirements Plan Performance on Contract Requirements- (measures forthcoming)
Measure Results in this Section (all measures listed alphabetically)
- Anti-Depression Medication Management
- Follow-up After Behavioral Health Hospitalization
- Follow-up Care for Children Prescribed with ADHD Medication
- Initiation and Engagement of Alcohol and SUD Treatment
- Pharmacotherapy For Opioid Use Disorders
Population Health
Edit PH Plan Performance on Contract Requirements Plan Performance on Contract Requirements- (measures forthcoming)
Measure Results in this Section (all measures listed alphabetically)
- Adult BMI Assessment
- Annual Dental Visit
- Breast Cancer Screening
- Cervical Cancer Screening
- Childhood Immunization Status
- Chlamydia Screening in Women
- Colorectal Cancer Screening
- Comprehensive Diabetes Care: Eye Exam
- Comprehensive Diabetes Care: HBA1C Control
- Comprehensive Diabetes Care: Nephropathy
- Controlling High Blood Pressure
- Flu Vaccinations for Adults
- Immunizations for Adolescents
- Medical Assistance With Smoking and Tobacco Use Cessation
- Medication Management for People with Asthma
- Pediatric Weight Assessment and Counseling
- Prenatal and Postpartum Care: Timeliness of Prenatal Care
- Prenatal and Postpartum Care: Postpartum Care
- Proportion of Days Covered: Diabetes All Class
- Proportion of Days Covered: RAS Antagonists
- Proportion of Days Covered: Statins
- Rating of All Health Care
- Rating of Health Plan
- Well-Child Visits Ages 0-15 Months
- Well-Child Visits Ages 3-6 Years
- (measures forthcoming)
Delivery System and Payment Strategies to Drive Quality
Edit DSPSTDQ Plan Performance on Contract Requirements Plan Performance on Contract RequirementsMeasure Results in this Section (all measures listed alphabetically)
- Primary Care Provider Assignment
- Primary Care Alternative Payment strategies
- Patient-Centered Medical Home enrollment
Measure Results in this Section (all measures listed alphabetically)
- Access to Care
- Access to Information
- Annual Monitoring for Persistent Meds
- Appropriate Testing for Pharyngitis
- Avoidance of Antibiotics for Bronchitis
- Care Coordination
- Plan Admission
- Plan All-Cause Readmissions
- Rating of Personal Doctor
- Rating of Specialist
- Use of Imaging for Back Pain
- (measures forthcoming)