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63 POPULATION 1/CCHIP

DHCS monitors quality standards in the CCHIP projects through:

• Analysis and trending of reports from health, dental and vision plans. DHCS staff will collect and analyze a variety of reports generated by participating plans, regulatory entities, and external review organizations to monitor the quality of care received and to focus plan efforts on areas needing improvement. These reports include:

1. Benefit Grievances: Benefit grievances filed by CCHIP Program subscribers with participating plans. Participating plans will be contractually required to report benefit grievances once a year. These reports will be shared with subscribers who request the information. In addition, DHCS will track any publicly available information on the number and type of benefit grievances filed by all subscribers enrolled in a participating plan (DMHC reports all benefit grievances filed with plans annually). Grievance information will be used by DHCS to identify plan performance needing improvement and to form the basis of future performance standards.

2. Regulatory Entity Reports: DHCS will work with the state’s two health insurance industry regulatory entities (the Departments of Insurance and Corporations) to assure that all publicly available data on health plan performance is known to DHCS.

• Monitoring the accreditation status of participating plans by entities such as the National Committee for Quality Assurance (NCQA).

• The specific indicators to be tracked will focus on child or adolescent specific outcome measures, such as:

a. Ambulatory Care – Emergency Department Visits (AMB-ED) b. Children and Adolescent Access to Primary Care Practitioners (CAP-CH) c. Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34-CH) d. Child Immunization Status (CIS-3) e. Immunizations for Adolescents (IMA-2)

To the extent feasible, DHCS intends to utilize the audited HEDIS measures generated by the California Cooperative Healthcare Reporting Initiative (CCHRI). CCHRI is a collaborative effort of purchasers, providers and plans who are committed to produce audited performance data on health plans that can be compared across plans and tracked over time. The health plans participating in CCHRI represent