Quality and Equity Performance

OHCA is responsible for developing, adopting, and reporting performance on a single set of measures for evaluating health care quality and equity across various health care entities. To promote high quality and more equitable health care for all Californians, OHCA adopted the OHCA Quality and Equity Measure Set in April 2025. OHCA is aligning with existing quality and equity measurement programs across California to limit administrative burden on health care entities. Combined, the following measure sets make up the OHCA Quality and Equity Measure Set:

• Payers: Department of Managed Health Care (DMHC) Health Equity and Quality Measure Set and stratification requirements;
• Physician Organizations: Center for Data Insight and Innovation Office of Patient Advocate (OPA) Health Care Quality Report Card measures (subset); and
• Hospitals: HCAI Hospital Equity Measures Reporting Program measure set and stratification requirements.

Fully integrated delivery systems will be measured across all three measure sets. OHCA will apply the same benchmarks used by each measure set to evaluate the performance of health care entities.

Adopting the OHCA Quality and Equity Measure Set is a starting point. OHCA is required by statute to regularly review and update its measure set. OHCA will continue to work with sibling state departments, stakeholders, and other partners to evolve the measure set, collaboratively address limitations, and strengthen quality and equity analyses. For further information, please refer to the Quality and Equity Measure Set memo.

OHCA Quality and Equity Measure Set for Payers and Physician Organizations#

Measure Name	Measures for Payers: DMHC Health Equity and Quality Measure Set	Measures for Physician Organizations: OPA Health Care Quality Report Cards (Subset)
Childhood Immunization Status+	X*	X
Colorectal Cancer Screening+	X*	X
Controlling High Blood Pressure+	X*	X
Glycemic Status Assessment for Patients with Diabetes (<8.0% and/or >9.0%)+	X*	X
All-Cause Readmissions	X	X
Asthma Medication Ratio	X*	X
Breast Cancer Screening Rate	X*	X
Child and Adolescent Well-Care Visits	X*	X
Immunizations for Adolescents	X*	X
Depression Screening and Follow-Up for Adolescents and Adults (Depression Screening and Follow-Up on Positive Screen)	X
CAHPS Health Plan Survey: Getting Needed Care (Adult and Child survey) or QHP Enrollee Experience Survey	X
Prenatal and Postpartum Care (Postpartum Care and Timeliness of Prenatal Care)	X*
Well-Child Visits in the First 30 Months of Life (0 to 15 Months and 15 to 30 Months)	X*

OHCA Quality and Equity Measure Set for Hospitals by Hospital Type#

Measure Name	General Acute Hospital Measures	Acute Psychiatric Hospital Measures	Children’s Hospital Measures
Designate an individual to lead hospital health equity activities+	X	X	X
Hospital Commitment to Health Equity Structural Measure+	X	X	X
Provide documentation of policy prohibiting discrimination+	X	X	X
Report percentage of patients by preferred language spoken+	X	X	X
Screen Positive Rate for Social Drivers of Health+	X	X	X
Screening for Social Drivers of Health+	X	X	X
All-Case Unplanned 30-Day Hospital Readmission Rate, stratified by behavior health diagnosis*	X	X
HCAHPS survey (Received information and education and would recommend hospital) *	X	X
Pneumonia Mortality Rate*	X	X
All-Cause Unplanned 30-Day Hospital Readmission Rate*	X
Cesarean Birth Rate (NTSV) *	X
Death Rate among Surgical Inpatients with Serious Treatable Complications*	X
Exclusive Breast Milk Feeding*	X
Vaginal Birth After Cesarean Rate (VBAC) *	X
All-Cause Unplanned 30-Day Hospital Readmission Rate in an inpatient psychiatric facility*		X	X
Screening for metabolic disorders*		X
SUB-3: Alcohol and Other Drug Use Disorder Treatment Provided or Offered at Discharge and SUB-3a: Alcohol and Other Drug Use Disorder Treatment at Discharge*		X
Pediatric experience survey with scores of willingness to recommend the hospital*			X