Press Release

For the first time since the pandemic began, the National Committee for Quality Assurance (NCQA) released its national health plan ratings, naming CalOptima one of the top Medi-Cal health plans in California. This is the seventh year in a row that CalOptima has earned recognition for leadership in quality.

CalOptima received a rating of 4 out of 5 in NCQA’s Medicaid Health Plan Ratings 2021. No other Medi-Cal plan in California earned higher than 4 out of 5. Only 16 Medicaid plans of the 185 reviewed nationwide scored higher. The NCQA ratings are based on standardized, audited data regarding clinical performance and member satisfaction.

“CalOptima’s seven-year record of outstanding quality is based on a commitment to provide our members with access to the best care possible,” said Supervisor Andrew Do, Chair of the CalOptima Board of Directors and Chairman of the Orange County Board of Supervisors. “Throughout the pandemic, CalOptima has strengthened engagement with community stakeholders and supported our members’ diverse and comprehensive needs.”

NCQA assesses Medicaid plan quality based on 39 clinical measures related to both preventive care and treatments. Preventive measures report whether members get services to keep them healthy, such as well-child visits, immunizations and nutrition counseling. Treatment measures gauge whether members receive appropriate care in response to illnesses and chronic diseases, including diabetes and high blood pressure. NCQA also evaluates a plan based on seven customer satisfaction dimensions, such as getting care quickly and how well doctors communicate.

The rating achievement comes on the heels of NCQA’s renewal of CalOptima’s Medi-Cal accreditation for three years, through July 27, 2024. Accreditation means that health plan operations meet rigorous requirements for consumer protection and quality improvement. CalOptima received 100% of the allowable points on its renewal review.

“Conscientious performance drives CalOptima’s top performance. Therefore, we thank the thousands of Orange County doctors and nurses for consistently delivering quality care to our members,” said Emily Fonda, M.D., MMM, CHCQM, Chief Medical Officer. “CalOptima shares this honor with the frontline providers who continually demonstrate their dedication to the vulnerable Medi-Cal population.”

A county organized health system, CalOptima provides publicly funded health care coverage for low-income children, adults, seniors and people with disabilities in Orange County, California. CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner. In total, CalOptima serves more than 847,000 members with a network of 9,300 primary care doctors and specialists as well as 42 acute and rehab hospitals.

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA’s HEDIS® is the most widely used performance measurement tool in health care. NCQA’s website (www.ncqa.org) contains information to help consumers, employers and others make more informed health care choices.