Annual Health Care Complaint Data Reports
The Office of the Patient Advocate produces annual reports about health care complaints made by California consumers to the Department of Managed Health Care, Department of Health Care Services, California Department of Insurance, and Covered California. These reports also include information about state consumer assistance centers.
Data Tables from the Measurement Year 2016 Report
(Released April 2018) - This third-year, multi-departmental report provides information on health care complaints resolved in 2016.
Data Tables from the Measurement Year 2015 Report
(Released January 2017) - This second-year, multi-departmental report provides information on health care complaints resolved in 2015.
Data Tables from the Measurement Year 2014 Report
(Released May 2016) - This baseline report is the first time in the state's history that a multi-departmental report on health care complaint data has been issued.
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The following reports on quality improvement were developed by the Department of Managed Health Care's Right Care Initiative (RCI), which focused on the care and prevention of strokes and heart attacks in patients with diabetes and heart disease. These publications analyzed data used in OPA's 2014 health Care Quality Report Cards to show improvement in cardiovascular care between 2006 - 2012.
Key Quality Indicators for Cardiovascular Prevention Among California Health Plans (2006-2012)
Right Care Initiative Use of the California Health Care Quality Report Card
California Health Plans vs. National Top 10 Performance - Selected HEDIS Measures Trend Analysis
Cardio-Protective Medication Bundle Protocol
Right Care Initiative University of Best Practices Brief
California Heart Attack, Stroke and Diabetes Care and Prevention - Publicly Available Data
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Racial and Ethnic Groups
Policy Brief: African Americans in Commercial HMOs are More Likely to Delay Prescription Drugs and Use the Emergency Room
This policy brief examines the assertion that HMO enrollees should be less likely to rely on emergency room and ambulatory care sensitive hospitalizations given HMOs focus on centralized care through use of a primary care provider. However, in this policy brief, researchers found that African-American HMO enrollees in California are more likely to delay obtaining needed medications and more likely to use the emergency room than other racial/ethnic groups in comparable HMO plans. The authors recommend a reexamination of use patterns and access barriers among African-American HMO enrollees.
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Health Care Engagement
Survey of Organizations about Health Care Reform Resources to Assist California Health Care Consumers
This report presents the findings of an electronic survey conducted among organizations serving California's health care consumers.& The survey was conducted in July 2012, for the California Office of the Patient Advocate and the Department of Managed Health Care to assess the needs for resources to help consumers navigate the changes and opportunities under Health Care Reform/the Affordable Care Act.
The Survey was conducted by U.C. Berkeley, Health Research for Action, using the Qualtrics web-based survey software program. Approximately 205 people were invited to fill out the 25-question online survey, and the response rate was 38%.
Investigating the Intersection Between Health Literacy and Health Plan Efficiency (Executive Summary)
The purpose of this report was to investigate the intersection between health literacy and health plan efficiency. To accomplish this, Health Research for Action (HRA - UC Berkeley School of Public Health) conducted a literature review, analyzed health literacy data from the California Health Information Survey (CHIS), conducted 31 key informant interviews with health plan professionals and advocates, conducted 12 focus groups and 20 usability tests with health plan members, and convened and met with an advisory group. HRA made recommendations based on this research and feedback from the expert advisory group.
From Patients to Partners: A Consensus Framework for Engaging Californians in Their Health and Health Care
This report on health care consumer engagement was created at OPA's request by the California Program on Access to Care (CPAC), a program of UC Berkeley’s School of Public Health. The resulting recommendations detail specific steps that can help health care consumers play a greater role in improving the quality of their health care, now and in the future.
The four major health care topics covered included:
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- Navigating the health care system
- Making choices among health plans and providers
- Influencing and managing the care they receive, including self management of chronic disease
- Adopting healthy behaviors
Quality of Care
Quality Performance Measurement in California (Executive Summary)
Full Report with Inventory
Inventory Only | Report Only
The objectives of the QPM project are:
- To identify useful measures for reporting the quality of health care in California.
- To assess health care stakeholders’ use of current and future quality measures, their perceived gaps in health care measurement, and their perceived role of OPA in quality measurement and public reporting.
- To assist OPA in developing strategies that contribute to the development of a coordinated and comprehensive set of publicly reported quality performance metrics for California.
Evaluation of California's Quality of Care Report Card
This report contains the results of an evaluation of the 2003-04 version of the OPA Quality of Care Report Card conducted by the Center for Health Services Research in Primary Care, University of California, Davis in 2004. It examined consumer use, usability, and usefulness of the Report Card website and printed summary. The Report Card website, updated annually, provides consumers with comparative information on the performance of California’s largest HMOs and medical groups serving approximately 11 million enrollees. It also includes a list of HMO services in other languages.
The website also provides detailed results for more than 50 specific quality measures. Both the web and print versions are available in English, Spanish, and Chinese.
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2010 Profiling California's Health Plan Enrollees
Fact Sheet - Large Enrollment in High-Deductible Health Plans
Fact Sheet - Mental Health Need and Treatment in California
This report, produced by the UCLA Center for Health Policy Research under contract to the California Office of the Patient Advocate, provides a pre-health care reform snapshot of health status and utilization characteristics of Californians who were either enrolled in commercial or public managed care plans or who were uninsured in 2007. Using the most recently available data from the 2007 California Health Interview Survey (CHIS), this report provides a detailed profile of demographic characteristics, disease conditions, health status, health care use, and barriers to care among California residents. Among the findings are a high need for certain types of health care, such as mental health services, as well as a growing reliance on high-deductible health plans, especially among the low-income and self-employed.
2006 survey: What Consumers Want to Know About Their HMOs
OPA recently commissioned a random sample survey of 1,224 adult Californians enrolled in HMOs. Goals of the survey were to:
- Determine the kinds of information HMO enrollees would like to know about their health plan and how it works.
- Identify the sources of information that consumers trust and the sources of information they find most useful. Specifically, the survey sought to understand how consumer information needs vary by source of coverage (employer, Medicare, or Medi-Cal), demographics, and geography.
- Document the changes in consumer experiences since 1997, when a similar survey was conducted.
2001 Profile of California's HMO Enrollees
This report, produced by the UCLA Center for Health Policy Research under contract to OPA, provides a detailed demographic profile of California's HMO enrollee population using data from the 2001 California Health Interview Survey (CHIS 2001). CHIS 2001, a new source of health information for California, is the largest state health survey ever conducted in the United States.
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2013 Policy Brief - Limited English Proficient HMO Enrollees Remain Vulnerable to Communication Barriers Despite Language Assistance Regulations
More than 1.3 million California HMO enrollees ages 18 to 64 do not speak English well enough to communicate with medical providers. This policy brief from the UCLA Center for Health Policy Research found that health plan enrollees with limited English skills reported the poorest health and were more likely to have difficulty understanding their doctors, placing this already vulnerable population at even greater risk.
Policy Brief - Language Barriers Pose a Risk for California HMO Enrollees
Among California’s adult HMO enrollees ages 18 to 64, 3.4 million speak a language other than English at home. Of those, almost 30% report not being able to speak English well or at all. Over one million of these HMO members with limited English proficiency are at risk of facing problems accessing health care services and receiving quality treatment.
HMO Services in Other Languages
California is a very diverse state, and the population enrolled in its HMOs reflects this diversity. HMOs are faced not only with the challenge of providing appropriate health care services to members, but also providing services to enable access to care for limited English proficient members. This report presents findings from the OPA Cultural and Linguistic Services Information for Health Plans Survey.
Policy Brief - Diversity in Language and Education Poses Challenges for Health Plans
California’s HMOs face serious challenges in meeting the needs of members who have diverse language proficiency and educational attainment. This policy brief summarizes findings from a report that is the most comprehensive profile of the state’s entire HMO membership available to date, including commercial, Medicare, Medi-Cal, and Healthy Families members.
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Policy Brief - More Than Half of Californians in HMOs Are Overweight or Obese
More than five million Californians enrolled in HMOs, over half of all HMO enrollees ages 12 to 64, are overweight or obese, based on the most recent data from the California Health Interview Survey.
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