Quality Improvement and Health Equity

Contra Costa Health Plan is dedicated to ensuring the highest standards of care and service for our members. We continuously monitor and improve our healthcare practices through performance measurement, member feedback, and collaborative initiatives with healthcare providers.  

Quality Improvement and Health Equity Program Structure

For detailed information on our Quality Improvement and Health Equity Program, including documents and evaluations by year, please see the links below: 

Program Description, Evaluation, and Workplans 

Quality Measures and HEDIS 

HEDIS® (Healthcare Effectiveness Data and Information Set) provides a comprehensive set of standardized performance measures that help us ensure the quality of care we deliver. Contra Costa Health Plan uses HEDIS measures to evaluate our performance in key areas such as preventive care, chronic disease management, and member satisfaction. Our commitment to quality is reflected by our performance in exceeding national performance benchmarks.   

Quality Measurement Resources: 

Value-Based Payments

CCHP is dedicated to aligning provider incentives with the quality of care delivered. Our Value-Based Payment Pay for Performance Program rewards providers for achieving high standards in patient care and outcomes. To review the program details and requirements, please see the program guides:

2025 Program Guide

2024 Program Guide

Health Education and Population Health

Contra Costa Health Plan is committed to promoting wellness and addressing health needs through our health education and population health programs. We offer providers access to our member-facing health education website and member newsletters which includes resources and tools designed to support our members' health. We also collaborate with providers to develop tailored health education materials, classes, and support resources. If you are interested in arranging health education classes or need educational support or materials for your office, please reach out to us at healtheducation@cchealth.org. Our health educators can do on-site classes, virtual classes, tabling at your site or at events, or one-on-ones with members.

Population Needs Assessment

Understanding the diverse needs of our community is vital to delivering effective healthcare services.  Our Population Needs Assessment identifies the health needs and characteristics of our members, with a focus on uncovering health disparities. This assessment informs our quality improvement efforts and helps us tailor our programs to better serve our population. 

2023 -Population Needs Assessment

2022 - Population Needs Assessment 

Contra Costa Health Plan is also actively involved in the Contra Costa County Community Health Assessment and Community Health Implementation Plan, an action plan aimed at improving health outcomes across all of Contra Costa County.  CCHP sits on Contra Costa’s CHA/CHIP steering committee and contributes by providing data, member input through our Community Advisory Committee, and in-kind staff support. 

Contra Costa Health Atlas is a tool available for easy on-demand access to local data.  Display data in a map, charts, or in a table. 

Access to Care

Ensuring timely access to care is a fundamental priority at Contra Costa Health Plan. We adhere to state access standards to guarantee that our members can easily reach the care they need. This includes monitoring and evaluating appointment scheduling, wait times, and the availability of urgent and routine care services. We are committed to maintaining these standards and continuously improving our access to care. 

Initial Health Appointment

At Contra Costa Health Plan, we prioritize the health and well-being of our new members by ensuring they establish care promptly.  To support effective care coordination, all new members are required to see their Primary Care Provider (PCP) within 120 days of enrollment. This initial visit is essential for establishing care, assessing health needs, and creating a personalized care plan. 

• Initial Health Appointment Provider Tip Sheet

Blood lead screening

Ensuring that all children receive timely blood lead tests is a key aspect of preventive care. According to California lead guidelines for Medicaid children, these tests are crucial for detecting and preventing lead exposure. We encourage providers to follow these guidelines and ensure screenings are completed. Guidelines and resources can be found below: 

Member Experience and Provider Satisfaction 

Contra Costa Health Plan values the feedback of both our members and providers. To continually improve our services and care, we conduct regular surveys to assess member experience and provider satisfaction. These surveys provide critical insights that guide our quality improvement initiatives, ensuring that we meet the needs and expectations of those we serve. Providers are encouraged to participate in these surveys to help us enhance our collaboration and overall service delivery.

Facility Site Review

Contra Costa Health Plan conducts facility site reviews in accordance with standards set by the California Department of Health Care Services (DHCS). These reviews are designed to ensure that healthcare facilities within our network meet state requirements for quality and safety. By adhering to these standards, we help ensure that our members receive care in environments that are safe, well-maintained, and properly equipped.   

• FSR tool  

Potential Quality Issues (PQI)

Potential Quality Issue (PQI) is a possible adverse variation from expected clinician performance, clinical care, or outcome of care. PQIs requires further investigation to determine whether an actual quality issue or opportunity for improvement exists. To report a potential quality issue, please fill out this form and email to qualityconcerns@cchealth.org.

• PQI Reporting Form

Clinical Practice Guidelines 

Contra Costa Health Plan is committed to supporting our providers with evidence-based clinical practice guidelines to ensure high-quality care and optimal patient outcomes. These guidelines cover a range of clinical areas and are regularly updated to reflect the latest research and best practices. Providers are encouraged to use these guidelines to inform their clinical decision-making and enhance patient care. All Clinical Practice Guidelines are reviewed and approved by CCHP’s Quality Council. 

For access to our clinical practice guidelines and related resources, please visit: 

Provider-Preventable Conditions (PPCs)

Provider Preventable Conditions (PPCs) include health care-acquired conditions (HCAC) in acute inpatient hospital settings and other provider-preventable conditions (OPPC) when they occur in any health care settings.  Federal law mandates that providers report PPCs occurring during the treatment of Medi-Cal patients. This includes PPCs associated with Medi-Cal claims or courses of treatment, except those that existed before the provider began treatment.    

Under the Federal Affordable Care Act section 2702 and Title 42 of the Code of Federal Regulations, sections 447, 434 and 438 also require that Medi-Cal and Medi-Cal Managed Care plans not reimburse for PPCs that occur during treatment. CCHP investigates all reported PPCs to determine if payment adjustment is necessary.  Providers must report PPCs within five (5) business days of discovery by contacting QualityConcerns@cchealth.org.  Please note that reporting PPCs for a Medi-Cal beneficiary does not preclude the reporting of adverse events and healthcare-associated infections (HAI) to the California Department of Public Health pursuant to Health and Safety Code. 

Contact Us

For any questions or concerns related to quality improvement or population health, please contact us at cchp.quality@cchealth.org. 

For questions or concerns related to patient safety, please contact QualityConcerns@cchealth.org