Wednesday, October 29, 2008


DMHC announces first “Right Care Initiative” award recipients

Kaiser Foundation Health Plan and Anthem Blue Cross honored for heart disease and diabetes care measures

(Sacramento) -- Cindy Ehnes, Director of the California Department of Managed Health Care (DMHC), announced the recipients of the first Right Care Initiative awards, honoring Kaiser Foundation Health Plan and Anthem Blue Cross for demonstrating outstanding progress toward meeting the national 90th percentile goals for heart disease and diabetes prevention and care.

“It takes too long for clinical best practices to catch up to the doctor’s office, leaving California patients vulnerable to needless strokes, heart attacks, blindness and amputations,” said Cindy Ehnes, Director of the DMHC. “These awards acknowledge California health plans committed to accelerating effective and inexpensive treatments to fight our biggest killers -- heart disease and diabetes.”

Awards are given annually to health plans meeting the goals of the DMHC’s Right Care Initiative, a three-year effort launched in 2008 to work collaboratively with health plans and medical groups focusing on three key areas: heart disease, diabetes and hospital-acquired infections. The goal is that, within three years, California managed care plans will stand out and score within the 90th percentile of national performance in these areas, based on the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) scores, a tool used by most U.S. health plans to measure performance on important dimensions of care and service.

According to the Kaiser Family Foundation, the number of workers with major chronic conditions such as heart disease, hypertension, diabetes and asthma, grew 25 percent between 1997 and 2006. In addition, NCQA, as well as the state-to-state comparisons from the Commonwealth Foundation, the Agency for Health Care Research and Quality, and U.S. News and World Report, show that California patients are not fully benefiting from the potential of managed care to improve quality.

The Right Care Initiative is based on principles contained in Governor Schwarzenegger’s health care reform plan, calling for improvement in prevention and care for major diseases and error-prone areas in California medicine. By bringing California’s health plans together to share and adopt best practices, the initiative has set its highest priorities on controlling the basic health measurements of blood pressure, cholesterol and blood sugar control which will hold down costs by making patients healthier.

The 2008 awards were given to the two health plans meeting the 90th national percentile for key areas on which the Right Care Initiative is based. Kaiser won the inaugural “Directors Right Care Award” for Best Performance Improvement in Heart Disease & Diabetes Prevention. Anthem Blue Cross received an honorable mention for Improvement in Blood Pressure and Cholesterol Control Measures.

Director Ehnes also acknowledges the support of the Deans of the UCLA and UC Berkeley Schools of Public Health and Johnson & Johnson for assisting with the formation of the Right Care Initiative.

The California Department of Managed Health Care is the only stand-alone HMO watchdog agency in the nation, touching the lives of more than 21 million enrollees. The DMHC has assisted more than 800,000 Californians resolve their HMO problems through its 24-hour Help Center, educates consumers on health care rights and responsibilities, and works closely with HMO plans to ensure a solvent and stable managed health care system.