The health plan that serves low-income people in three California counties has been below the state’s minimum performance level for more than a year, according to quarterly assessments from the state agency that oversees the health plan.

The Anthem Blue Cross Medi-Cal program in Alameda, Contra Costa and Kings counties has consistently failed the Department of Health Care Services’ quarterly assessments by scoring below 40 percent. Alameda and Contra Costa’s plans have been below the minimum performance level since 2011, according to DHCS, the agency responsible for overseeing Medi-Cal health plans.

Medi-Cal is California’s version of Medicaid, a federal program that provides insurance to low-income children and adults. The assessment is one measure the health care agency uses to determine the quality of health plans that use state and federal money to operate.

The weighted average score on the quarterly assessment for Medi-Cal plans in California counties was 58 percent, according to the agency’s March report. Some counties’ plans, such as Kaiser Permanente in Sacramento and San Diego, scored above 90 percent.

Anthem Contra Costa scored 37 percent, while Alameda and Kings scored 31 percent

The low performance scores call into question whether people in those plans — some of the most vulnerable in the state — are receiving adequate care.

Data issues?

The state creates its minimum performance level rankings using data on how well health plans have treated certain conditions or done preventative care. Some of the factors include controlling high blood pressure, comprehensive diabetes care, childhood immunizations, medication management for people with asthma, prenatal and postpartum care, well-child visits and weight assessments for children.

Anthem Blue Cross says that the low scores don’t reflect the quality of their plan, but that some of the counties didn’t properly record data on how they treated patients, which is used to measure how well they perform.

“In previous years, Anthem provided quality care for our members, but did not collect all the needed data from doctors to provide information for the state’s reporting system,” Anthem Blue Cross spokesman Darrel Ng said of the Alameda, Contra Costa and Kings county plans.

Health care agency spokesman Anthony Cava agreed that the low scores “do not necessarily mean poor service, but could also reflect data issues.” Cava added that a 2013 survey by the U.S. Department of Health and Human Services “showed good satisfaction from Anthem Blue Cross members in these three counties.”

According to that survey, people enrolled in those plans reported varying levels of satisfaction, between about 48 and 79 percent. While the ratings are comparable to those in other plans, two of the scores are on the low end. Only about 48 percent of adults enrolled in Alameda County’s Anthem plan reported being satisfied with their personal doctor, and about 57 percent of people in Kings County’s Anthem plan were satisfied with their child’s doctor.

If the data the counties have collected is unreliable, it makes it difficult to assess whether they are serving patients adequately, said Chris Perrone, director of improving access at the California HealthCare Foundation.

“It is a problem that we don’t know, and if one’s going have these performance measures in place and then fall back on ‘they don’t actually reflect what’s actually going on,’ then we need better measures of performance,” he said.

Ng said he expects scores for the plans to improve soon.

“In the past year, Anthem’s health care quality team has made capturing accurate documentation and data a priority, in partnership with key providers across our 29 Medi-Cal counties,” he said.

Perrone said that when other county plans, such as the San Francisco Health Plan, have fallen below the minimum level and then improved, they have said it was because they fixed data problems.

But it’s unclear, Peronne added, whether that same pattern is happening with Alameda, Contra Costa and Kings counties, or whether the low scores also reflect other problems.

Even when a plan has repeatedly failed its performance assessment, the department is not required to notify people enrolled in that plan that it is not measuring up.

The next state report, with updated scores, will be released in the first half of June, Cava said.

An improvement plan

The health care agency says it is working with Anthem to improve the plan’s performance in Alameda, Contra Costa and Kings counties.

“For the counties that are below the MPL (minimum performance level), we are working with them to improve the specific measures,” Cava said.

In November 2013, the agency issued a corrective action plan to Anthem for having a history of poor performance on the quarterly rankings. The three-year plan was designed to improve performance in Alameda, Contra Costa, Fresno, Kings, Madera, Sacramento, San Francisco, Santa Clara and Tulare counties. Six of the counties have improved above the minimum performance level since then, according to the agency’s March report.

As part of the corrective plan, Anthem had to do three quality-improvement projects focusing on diabetes care, prenatal and postpartum care and childhood immunizations. It also had to create two plans for improving well-child exams and monitoring persistent medications.

A revised corrective plan, issued September 2014 and effective for the following three years, requires Anthem to do two additional quality-improvement projects focusing on controlling blood pressure and medication for people with asthma.

In addition to issuing corrective plans, the agency can also impose sanctions on plans when they “demonstrate persistent poor performance,” Cava said. So far Anthem’s plan has received no sanctions.