2023 Health Plan Performance Report
About the Report
Covered California is committed to holding insurers accountable for ensuring that members get the right care at the right time. Through its annual contract requirements, Covered California requires every health insurance issuer that sells plans through the Exchange to submit data demonstrating how their plans perform every year. This report, the Plan Performance Report, publicly displays the information Covered California requires plans to submit to demonstrate performance related to disparities reduction, cost reduction or quality improvement.
This 2023 report is the second report and generally includes performance measures from plan years 2020 and 2021. Please note, however, that some individual measures may include additional years for purposes of trending or fewer years if there are specific data quality restrictions. Measure results released each year will be available on a rolling basis as they are finalized. All measure results here have met Covered California’s criteria for public reporting, including:
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All data has been assessed for validity, reliability, and completeness.
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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
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Data sources are cited (see Data Sources here) and non-standard measures are documented
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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
Measure Results in this Section (all measures listed alphabetically)
- Ambulatory Emergency Room Visits
- Breast Cancer Screening
- Child And Adolescent Well-Care Visits
- Diabetes Hemoglobin A1c Testing
- Proportion of Days Covered: Diabetes All Class
- Proportion of Days Covered: RAS Antagonists
- Proportion of Days Covered: Statins
Behavioral Health
Edit BH Plan Performance on Contract Requirements Plan Performance on Contract Requirements- Telehealth Availability
Measure Results in this Section (all measures listed alphabetically)
- Annual Monitoring For Persons on Long-Term Opioid Therapy
- Antidepressant Medication Management
- Follow-up After Hospitalization for Mental Illness (7 Days)
- Follow-up After Hospitalization for Mental Illness (7 & 30 Days)
- Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
- International Normalized Ratio Monitoring for Individuals on Warfarin
- Pharmacotherapy For Opioid Use Disorders
Population Health
Edit PH Quality Rating System (QRS) Measure Results Quality Rating System (QRS) Measure ResultsMeasure Results in this Section (all measures listed alphabetically)
- Annual Dental Visit
- Asthma Medication Ratio
- Breast Cancer Screening Rate
- Cervical Cancer Screening
- Childhood & Adolescent Well-Care Visits
- Childhood Immunization Status (Combo 3)
- Childhood Immunization Status (Combo 10)
- 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 (Combo 2)
- Medical Assistance With Smoking and Tobacco Use Cessation
- 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
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children & Adolescents
- Well-Child Visits Ages 0-30 Months
- Well-Child Visits Ages 3-6 Years
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)
- Participation in ACOs or IDSs
- Participation in Organizations and Collaboratives
- Patient-Centered Medical Home enrollment
- Primary Care Alternative Payment strategies
- Primary Care Provider Assignment
- Hospital Safety
- Maternity Hospital Honor Roll
Measure Results in this Section (all measures listed alphabetically)
- Access to Care
- Access to Information
- Appropriate Testing for Pharyngitis
- Appropriate Treatment for Children with URI
- Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
- Care Coordination
- Plan Administration
- Plan All-Cause Readmissions
- Rating of Personal Doctor
- Rating of Specialist
- Use of Imaging Studies for Low Back Pain