Indicator Description: Percentage of Californians who receive care in an integrated system, defined as a Health Maintenance Organization that is tracked by the Department of Managed Health Care. Managed care refers to health care coverage that organizes doctors, hospitals and other providers into groups in order to enhance the quality and cost effectiveness of medical treatment. Today, 58 California counties receive their health care through six main models of managed care: Two-Plan, County Organized Health Systems (COHS), Geographic Managed Care (GMC), Regional Model (RM), Imperial, and San Benito.2
Data Limitations: County enrollment information is compiled by Department of Managed Health Care Licensed Full-Service Health Plans. This enrollment information is not standardized and may be designated by the member’s place of employment or home resulting in reporting inaccuracies.
Indicator Source: Department of Managed Health Care – Office of Plan Monitoring.
Indicator Calculation Methodology: Numerator is number of enrollees in a Health Maintenance Organization by county. Denominator is the county population from the Department of Finance. Percentage is numerator divided by denominator.
Data Collection Methodology: Department of Managed Health Care Licensed Full Service Health Plans compile member enrollment information by county. These Plans submit this enrollment information on a standardized template to the DMHC website on an annual basis.
Program URL Link: http://www.dmhc.ca.gov/LicensingReporting/HealthPlanComplianceMedicalSurvey.aspx#.WJIZNk2Qzc
1. Scheffler, R. M., & Bowers, G. L. (2013). A New Vision for California’s Healthcare System: Integrated Care with Aligned Financial Incentives. Berkeley: University of California, Berkeley.
2. MEDI-CAL MANAGED CARE PROGRAM FACT SHEET – Managed Care Models. (2014, November). Retrieved December 16, 2015, from www.dhcs.ca.gov