Welcome to our October 31st "Community Pulse" newsletter; a bi-monthly publication filled with community tips, health news, and much more! 

October 2017 -  In This Issue:

CenCal Health Members Have Access to See Their Doctors in a Timely Manner

CenCal Health Earns Excellent Rating and Recognition Amongst California's Medicaid Plans

Breast Cancer Awareness

Sponsored Community Events

CenCal Health Membership Totals

4050 Calle Real
Santa Barbara, CA 93110

1288 Morro Street
Suite 100
San Luis Obispo, CA 93401

Toll Free: (800) 421-2560
Tel: (805) 685-9525
CenCal Health Members Have Access to See Their Doctors in a Timely Manner

The Department of Health Care Services (DHCS) issued the new final rule regarding Network Adequacy Standards taking effect on July 1, 2018. There are no changes to the time and distance standards for Primary Care Physician's (PCP), which remains as "10 miles or 30 minutes from a member's address." Access standards have changed for 15 core specialties providers:

  • Cardiology
  • Dermatology
  • Endocrinology
  • Otolaryngologist (ENT)
  • Gastroenterology
  • General Surgery
  • Hematology/Oncology
  • HIV/AIDS Specialists/Infectious Diseases
  • Nephrology
  • Neurology
  • Ophthalmology
  • Orthopedic Surgery
  • Physical Medicine and Rehabilitation
  • Psychiatry
  • Pulmonology

The standards changed from a requirement of "reasonable access" to 45 miles or 75 minutes from a member's physical address. This change applies to counties that are identified as "Small Counties", such as Santa Barbara and San Luis Obispo. Ninety-nine percent of CenCal Health's member population is in the time and distance access parameters for PCP and Specialty providers.

Another component to timely access is the time it takes to obtain an appointment. CenCalHealth collected data through their annual "appointment availability audit," which was conducted to determine rates of compliance for members obtaining an appointment . This rate of compliance is set forth  per the timely access regulations  designated  by the Department of Managed Health Care (DMHC).
Our findings indicate that  91  % of PCP's that participated in the survey were compliant with the standard for the amount of time it takes to get an appointment for urgent-care and 9 0 % were compliant for non-urgent care appointments.
86% of Specialists were compliant with the standard for the amount of time it takes to get an appointment for specialty urgent care and 70% were compliant for non-urgent appointments. 8 of 14 Dermatology providers surveyed did not meet the standard for non-urgent appointments. We've identified Dermatology as an area of concern and will continue to collaborate with the provider network to recruit new providers, particularly the large groups. The grid below indicates the appointment wait time set forth by DMHC.

CenCal Health's provider network, which spans Santa Barbara and San Luis Obispo counties, affords our members freedom to access providers throughout our service area. This helps in supplementing access particularly as some areas of services are rural and geographically isolated. Through routine analysis of our network access and availability reports, we are able to monitor for potential access issues. CenCal Health prides itself in minimizing or resolving access concerns before they become a significant issue.
CenCal Health greatly values their member's opinions as such they conducted a Member Timely Access Survey in 2016. The report utilizes a sample of membership continuously enrolled for the last 6 months of 2016, and a methodology for random sampling, which followed the design used by the Consumer Assessment of Healthcare Providers and Systems (CAHPS).
The report's key findings indicated:

  • 85% of children and 83% of adults felt they received care right away, when they thought they needed it.
  • 71% of children and 69% of adults responded that it was easy to get an appointment for routine care with a specialist.
  • 57% of children and 75% of adults thought it was easy to get services like tests, lab-work, x-rays, medications or supplies through the Health Plan.

Lastly, it's important to note that 84% of child subscribers and 79% of adult members stated it was easy to get help from our Member Services Department.

CenCal Health will continue to work to improve timely access to care for members through pro-active approaches - such as increasing availability for after-hours access, partner with providers on recruitment activities, and provide member education on access to care.

CenCal Health Earns Excellent Rating and Recognition Amongst California's Medicaid Plans

CenCal Health rated in the top 5 percent of Medicaid plans nationally for 2 important areas of care, and in the top 10 percent for an additional 12 areas of care according to the most recent state quality measurement ratings. For CenCal Health's Santa Barbara County managed care product, these exceptional results rated fourth statewide among Medi-Cal health plans.

The State of California began evaluating industry-standard quality indicators 18 years ago, and this year marks the best overall performance that CenCal Health has ever achieved. CenCal Health's performance is assessed annually using HEDISĀ®, which is the measurement tool used by the nation's health plans to evaluate their performance in terms of clinical quality and customer service.
We thank our healthcare providers, hospitals, and our partners for helping us give the best care possible to our members. This achievement would not be possible without the support of our stakeholders. We take pride in the care our physicians and hospitals provide to each and every patient.

High performance levels were achieved in Santa Barbara and San Luis Obispo counties in diabetes care, prenatal care, and nutritional and physical activity counseling among children and adolescents. Additionally, in Santa Barbara County, excellent results were achieved in asthma treatment. This means healthier pregnancies, healthier children in school, and better management of diseases like diabetes and asthma, and that is important for our entire community's health.


The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by the California Department of Health Care Services, CenCal Health, and more than 90 percent of America's health plans to measure performance on important dimensions of care and service.  HEDIS is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare health care quality.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). NCQA is a private, non-profit organization dedicated to improving health care quality. It accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA's Web site ( www.ncqa.org ) contains information to help consumers, employers and others make more informed health care choices.

If you would like to learn more about these services, visit CenCal Health's website at  www.cencalhealth.org  or call (800) 421-2560. Detailed results from our performance are available on the CenCal Health website at  www.cencalhealth.org/providers/quality-of-care/hedis

Breast Cancer Awareness

National Breast Cancer Awareness Month was established in October 1985 as a partnership between American Cancer Society and Imperial Chemical Industries designated to be an observed commemorative month to raise awareness of breast cancer. The early mission was to educate and empower women, which gained much momentum in the first week with support from well-known public figure and breast cancer survivor Betty Ford and her daughter.

In 1993, President Clinton declared the third Friday of October as "National Mammography Day," encouraging clinics, health organizations and radiologist to provide discounted or free screening on this day. CenCal Health encourages all women ages 50 - 74 to have a mammogram every 1-2 years. Getting routine mammograms help to make sure that cancer is found early, when it is easier to treat. Finding breast cancer early can help save your life!

For more information regarding breast cancer, please visit our website at https://www.cencalhealth.org/health-and-wellness/womens-health/

Sponsored Community Events

November 2nd - Live Well Santa Barbara County
"Healthy Eating Active Living (HEAL) Summit"
November 4th -Wilshire Hospice
Annual Fundraising Event

November 4 th - Access Support Network
26 th Annual Walk for Life

November 4th - Arts for Living
Annual Fundraising Event
November 5th - Senior Volunteer Services
Annual Fundraising Event
November 12th - Foodbank of Santa Barbara
"Empty Bowls"