2024 Community Report

Our Collective Impact

A message from our CEO

Together with our partners, CenCal Health is now one year into carrying out the transformative priorities of our 2023-2025 Strategic Plan. As a tribute to the efforts of so many, we have dedicated this Community Report to highlighting the collaborative accomplishments achieved through the California Advancing and Innovating Medi-Cal (CalAIM) program. Through this ground-breaking CalAIM program, CenCal Health is addressing the social determinants of health and leading towards the bold vision set by our Board of Directors. This vision is to be a trusted partner in advancing health equity so that our communities thrive and achieve optimal health.

I am immensely proud of our collective impact to cultivate community partnerships, advance quality and health equity for all, and expand our role and reach. These new benefits and programs drive positive change. I wish to express my gratitude to our employees for their compassionate service, as we organize internally for impact and effectiveness both now and in the future.

Last year, CenCal Health marked 40 years serving Medi-Cal members in Santa Barbara County and 15 years in San Luis Obispo County. The decades-long collaboration with our provider network and commitment to local service organizations strengthens the health system by improving access and driving higher quality health care access to those we serve. As we continue to work together, I am confident we will reach new heights through local innovation and build healthier communities – together.

Marina Owen, CenCal Health CEO

Who we are

CenCal Health is the local Medi-Cal Managed Care health plan in Santa Barbara and San Luis Obispo counties.

We are committed to improving our communities' health and well-being by providing members access to high-quality healthcare services, education, and outreach.

But we don't do it alone. Every one of our provider partnerships is essential to serve our members.

To view our Provider Directory, click here.

Partnering
with over
5,000 local
physicians

Contracted
with 4,000+
specialty
providers

Who we serve

CenCal Health serves low-income individuals and families with Medi-Cal coverage in our service areas.

241,000+

Total membership as of February 2024

36%

Children & teens
ages 0-17

56%

Adults
ages 18-64

8%

Seniors
ages 65+

Click here to view our member demographics

1 in 3
Santa Barbara
County residents covered

1 in 4
San Luis Obispo
County residents
covered

We’re working to meet the evolving needs of our communities and Medi-Cal goals.
HERE'S HOW:

1

Expanding our service role and reach by leading the implementation of expanded Medi-Cal programs and benefits, including preparing for the effective implementation of CalAIM.

2

Cultivating community partnerships by serving as a partner with health and social service organizations, facilitator of community integration and coordination, and leader in understanding and addressing issues of health equity.

3

Advancing quality & health equity
for all by taking steps to meet and exceed increasing Medi-Cal quality requirements and expectations to ensure all our members attain optimal health.

4

Organizing for impact and effectiveness internally within the organization to support meeting our priorities of expanding our service role and reach, cultivating community partnerships, and advancing quality and health equity for all.

Learn more about these priorities in our Strategic Plan.

Expanding services for members
with complex needs

Since July 2022, CenCal Health has launched nearly a dozen new services under CalAIM to support members facing difficult life circumstances that affect their health and wellness. As of December 2023, nearly 3,000 members have received CalAIM services.

CalAIM’s impact on our members

15,495

Hours of care provided to members through Enhanced Care Management to support their clinical and non-clinical needs.

14,787

Medically Tailored Meals provided to members with complex care and health needs to support their nutritional wellness.

5,794

Days of care provided to members experiencing homelessness and needing a safe space to recover post-hospitalization.

$317,064

Provided in housing deposit assistance to support housing-insecure members in renting an apartment or home.

CenCal Health provides members a range of CalAIM services through Community Supports and Enhanced Care Management. To learn more about these services, click here.

CalAIM — short for California Advancing and Innovating Medi-Cal — focuses on providing Medi-Cal members with well-rounded care beyond the doctor's office or hospital. CalAIM works to address complex economic and social conditions that affect health, such as lack of food, housing, involvement with the justice system, and transportation. Led by the California Department of Health Care Services, CalAIM is a multiyear plan that will transform the Medi-Cal program across the state and make it integrate more seamlessly with other social services.

How our members rank their experiences

Out of 24 California health plans, CenCal Health ranks:

#1 in customer service for adult members

#2 in getting care quickly for adults and children

#4 in overall rating of health plan for adults & children

Results are based on the 2023 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey Report.
CAHPS is a standardized survey instrument used to assess the patient experience of health plan members.

CAHPS is a registered trademark of the Agency for Healthcare Research and Quality.

Expanding our service role and reach

Enhancing the availability of Medi-Cal services and benefits can result in superior healthcare for vulnerable community members. CenCal Health is actively working to extend its role and reach through CalAIM and expanding coverage to residents newly eligible for Medi-Cal.

Community Supports take members from homeless to homed

CenCal Health has partnered with providers and community service organizations to offer CalAIM Community Supports that address the holistic needs of unhoused members. Through these services, members can obtain help finding stable housing, securing funds for housing deposits, receive case management, mental health and substance use treatment, and beyond. The goal is to care for the underlying issues that contribute to homelessness and improve people's overall quality of life.

Click here to read more

CenCal Health prepares for Medi-Cal expansion

Expanding full-scope Medi-Cal coverage to all eligible Californians is crucial to building a healthier and inclusive state supported by an equitable healthcare system. New legislation scheduled to take effect in January 2024 established California as the first state in the nation to offer full-scope Medi-Cal benefits to all eligible residents, regardless of their immigration status. California had previously expanded Medi-Cal, regardless of immigration status, to residents aged 19 to 26 and seniors aged 50 and above. The latest age group to become eligible for full-scope benefits under the new legislation were adults ages 26-49.

Click here to read more

Sobering sanctuary provides members a safe and supportive environment

Individuals under the influence of drugs and alcohol impact the entire community, endangering themselves and others. Where does someone go to take the first step to begin treating addiction challenges? Sobering Centers are a Community Supports service offered to CenCal Health members needing to recover from the effects of alcohol and drug use. In 2023, Sobering Centers were CenCal Health’s most utilized Community Supports service. Out of 70 sobering centers that are known to operate worldwide, two are located in Santa Barbara and Santa Maria.

Click here to read more

Giving back to our communities

Over $530,000 provided in funding to community service organizations

600 pounds of food donated by staff to support local shelters

850 diapers donated by
our staff to support local families

Cultivating community partnerships

We proudly serve as a dedicated partner to our local healthcare providers, leaders of social services, and government agencies. Together, we seek to enhance the healthcare system, promote the well-being of our communities, and effectively coordinate efforts to address Medi-Cal reforms and local healthcare needs.

Celebrating 40 years of partnerships

Collaboration is a deeply held value in our region. Over four decades ago, the Santa Barbara County medical community had the foresight to come together and organize a more effective way of managing care for the most vulnerable among us. Fifteen years ago, the San Luis Obispo County medical community became an invaluable partner in expanding CenCal Health’s service to the area.

Click here to read more

County supervisors commemorate our years of service

Embracing our role as a humble partner with local government agencies is essential to advancing Medi-Cal goals and addressing local issues and interests. Throughout the years, we’ve concentrated on aligning efforts with the healthcare priorities set by our elected county supervisors, who are entrusted with making important decisions for the betterment of our communities.

Click here to read more

Working collaboratively to ensure members keep their coverage

Due to the COVID-19 Public Health Emergency, Medicaid beneficiaries were not required to re-prove eligibility for three years. However, this exemption ended in 2023. Across the nation, there were massive enrollment losses due to various re-enrollment challenges, including complex requirements, a lack of public awareness, and challenges with contacting enrollees after three years that saw displacement caused, in no small part, by COVID’s impact on the economy.

Click here to read more

Our providers drive top
Medicaid ratings in quality
of care

CenCal Health’s success is a reflection of our dedicated provider network.

Rated top 5% in the nation

Completing 30-day follow-up after ED visit for alcohol & other drug abuse or dependance

Rated top 5% in the nation

Timeliness of women’s postpartum care

Rated top 10% in the nation

Low rate of diabetic members with poor blood sugar level control

Rated top 10% in the nation

Well Child Exams
for age 15 months to 30 months*

Rated top 10% in the nation

Immunizations for Adolescents*

Rated top 10% in the nation

Breast Cancer Screening*

Ratings are based on the Healthcare Effectiveness Data and Information Set (HEDIS®). CenCal Health’s HEDIS measurements are independently audited and reported annually to the National Committee for Quality Assurance (NCQA) to validate the quality of care rendered by our providers. HEDIS® is a registered trademark of the NCQA. 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. NCQA accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS®, the most widely used performance measurement tool in health care. Click here to view our HEDIS ratings for the measurement period ending on December 31, 2022.

*Santa Barbara County

Advancing quality & health equity for all

Our organization is committed to addressing health disparities that affect our members and vulnerable communities. We are actively implementing health equity strategies in collaboration with our provider network to ensure that our health plan meets and exceeds quality expectations.

Recuperative Care: Where the unhoused heal

Living on the streets is a struggle. For food. For shelter. For safety. Now imagine what happens when an unhoused individual needs surgery or is discharged from a hospital; where can they find a safe place to recover? Recuperative Care is one of the Community Supports that CenCal Health offers members under CalAIM. Community-based organizations offering Recuperative Care beds provide a stable, clean place for people experiencing homelessness to receive medical care coordination following a hospitalization or physical illness or injury.

Click here to read more

Primary care providers recognized, rewarded for quality of care

CenCal Health’s Quality Care Incentive Program is a pay-for-performance program that directly rewards plan providers who deliver exceptional medical care to CenCal Health patients. Since the program’s launch in March 2022, CenCal Health has distributed $27.0 million to 98 unique Central Coast primary care providers.

Click here to read more

Achievements in quality & health equity yield State award

In October, CenCal Health received a 2023 quality award from the Department of Health Care Services. Highlighting the work and accomplishments of healthcare providers in the plan’s network, the Certificate of Achievement was presented to CenCal Health for its notable achievement for various quality of care measures, which advance the Department of Health Care Services’ Bold Goals for 2025.

Click here to read more

99%
Of members
rate customer
service helpful
and friendly

98%
Of members
agree service
reps helped as
much as
they could

97%
Of member
questions and
issues
resolved during
the first
call

106,000+
Member
calls
received
annually

Results are based on a survey measuring CenCal Health members' satisfaction.

Organizing for impact and effectiveness

To be a trusted leader in advancing health equity, fulfill our mission, and champion the transformation of the Medi-Cal Program, CenCal Health has been organizing within the health plan to achieve exceptional results. We recognize that we must embrace innovation and new approaches that will best serve our stakeholders and communities.

Members express gratitude for our service representatives

For our dedicated service representatives, working efficiently to ensure a positive and valuable experience for our members is a round-the-clock commitment. To properly understand and empathize with our member's needs, concerns, and emotions, call center representatives must not only address routine questions but also provide an emotional and human connection to support our members' overall satisfaction and well-being — sometimes, during challenging and urgent situations.

Click here to read more

Leader recognized for service to most vulnerable

In August 2023, CenCal Health’s Associate Director of Utilization Management Ana Stenersen received the 14th Annual Making a Difference award from the Washington, D.C.-based Association for Community Affiliated Plans (ACAP). ACAP is the national trade organization representing not-for-profit Safety Net Health Plans, of which CenCal Health is a member. “Ms. Stenersen’s passion exemplifies what the Making a Difference Award is all about,” said Enrique Martinez-Vidal, ACAP Vice President for Quality and Operations.

Click here to read more

Ensuring financial strength and accountability

As a public agency, CenCal Health contributes approximately $85 million a month to the local economy, primarily through payments to healthcare providers who serve our membership.

Providing excellent, high-quality services to Medi-Cal members while being exceptional stewards of taxpayer dollars is a top priority for the health plan. During the 2022/2023 fiscal year, ninety-one cents of every dollar spent went directly to finance medical benefits and services provided to our members.

Click here to read more

Investing in our communities’ health and wellness
FISCAL SNAPSHOT:

$85M

Contributed monthly to the local economy, primarily through payments to healthcare providers who serve our membership.

$36.5M

Distributed to primary care providers in payments and incentives to ensure our members receive timely and high-quality care.

$5.9M

Invested in providing CalAIM services to our members through payments to our providers and community partners.

91¢

Of every dollar are spent on medical benefits and services provided to our members.

We are guided by passionate leadership

CenCal Health is governed by a 13-member Board of Directors, appointed by the Santa Barbara and San Luis Obispo counties’ Boards of Supervisors. The CenCal Health Board includes representatives from local government and county representatives, which have no term limits. Other positions include physicians, hospital administrators, and representatives from the business community and membership, many of whom have served our organization for multiple years. In 2023, pediatric physician Dr. René Bravo chaired the Board meetings. In January 2024, Tenet Health Central Coast CEO Mark Lisa was appointed as the new Board Chair.

Our Board of Directors

Mark Lisa

CEO of Tenet Health Central Coast, Chair of the Board
Hospital Representative
San Luis Obispo County
Kieran Shah

President & CEO of VNA Health, Vice Chair of the Board
Provider Representative
Santa Barbara County
Antonette Navarro

Director of
Behavioral Wellness
County Representative
Santa Barbara County
Daniel Herlinger

Consumer
Representative
Community Business
Santa Barbara County
Dawn Ortiz-Legg

Board of Supervisors
District 3
County Supervisor
San Luis Obispo County
Edward Bentley

Santa Barbara
Gastroenterology Consultants
Provider Representative
Santa Barbara County
Joan Hartmann

Board of Supervisors
District 3
County Supervisor
Santa Barbara County
Mouhanad Hammami

Director of
Public Health
County Representative
Santa Barbara County
Nicholas Drews

Director of
Health Agency
County Representative
San Luis Obispo County
René Bravo

Physician
Bravo Pediatrics
Provider Representative
San Luis Obispo County
Sara Macdonald

Consumer
Representative
Medi-Cal Recipient
Santa Barbara County
Sue Andersen

President & CEO of Marian Regional Medical Center
Hospital Representative
Santa Barbara County