Thursday, October 6, 2011


DMHC announces “Right Care Initiative” award recipients

Health plan and medical groups honored for work to fight diabetes and heart disease among HMO patients

(Sacramento) -- The California Department of Managed Health Care (DMHC) has announced recipients of the fourth annual Right Care Initiative (RCI) awards. This year’s top award goes to Kaiser Health Plans of Northern and Southern California for ranking in the 90th percentile of national performance in controlling blood pressure and cholesterol for cardiovascular, hypertensive and/or diabetic patients, among the nation’s most prevalent and devastating chronic diseases. Awards are given annually to California health plans meeting the goals of the DMHC’s Right Care Initiative, a public-private collaborative effort launched in 2008, to improve clinical quality in three key areas: heart disease, diabetes, and hospital-acquired infections, and to rank among the best in the nation.

“When the DMHC launched the Right Care Initiative in 2008, not one California health plan ranked in the 90th percentile in controlling many of the factors which lead to heart attacks and strokes,” said Shelley Rouillard, Chief Deputy Director of the DMHC. “But this effort shows that with health plans, medical groups and the community working together, we can achieve dramatic improvements in health plan quality measures.”

Eight of the nine largest health plans in California have made overall improvements on heart and diabetes quality measures since 2007, the year which was used as the Right Care Initiative’s baseline level of performance. The data is from HEDIS (Healthcare Effectiveness Data and Information Set) scores, which measures American health plan performance on important dimensions of care and service. According to national quality experts, meeting the 90th percentile by the largest health plans in heart and diabetes scores could save the lives of more than 2,000 Californians annually through the prevention of heart attacks and strokes.

In addition, 11 medical groups in California have reached the 90th percentile of clinical control measures in blood sugar and cholesterol. This is the first year in which the DMHC has included medical groups, not only health plans, in its Right Care Initiative awards. The medical groups include:

  • Arch Health Partners - Poway
  • Edinger Medical Group - Fountain Valley/Huntington Beach
  • John Muir Physicians Network - Concord
  • Mercy Medical Group/CHW Medical Foundation - Sacramento
  • Palo Alto Medical Foundation – Mills Peninsula Division - Palo Alto
  • Scripps Medical Group - San Diego
  • Sharp Rees-Stealy Medical Group - San Diego
  • St. Joseph Heritage Medical Group - Orange County
  • St. Jude Heritage Medical Group - Fullerton
  • Sutter Gould Medical Group - San Joaquin/Stanislaus County
  • UCLA Medical Group - Los Angeles

The statewide goal of the Right Care Initiative is to reach the 90th percentile in heart and diabetes HEDIS control measures of blood pressure, blood sugar and cholesterol for the prevention of heart attacks and strokes, and to cut the rate of death from hospital acquired infections through concerted action. Key partners include California health plans and medical groups, the California Chronic Care Coalition, University of California, Stanford University, RAND, American Diabetes Association, American Heart/Stroke Association, California Hospital Association, California Medical Association Foundation, California Pharmacy Foundation and other disease-based and community organizations throughout the state. The annual awards were presented at the fourth annual Right Care Initiative Dean’s Summit, held on October 3 at UC San Diego.

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 one million Californians to resolve their health plan problems through its Help Center, educates consumers on their health care rights and responsibilities, and works closely with health plans to ensure a solvent and stable managed health care system.