Sacramento County faces significant challenges in health care quality, access, and outcomes among Medi-Cal enrollees.

Sacramento County has long struggled with differences in health care quality, access, and outcomes among enrollees in Medi-Cal, California’s Medicaid program. These differences are influenced by a complex interplay of factors, including race, ethnicity, geographic location, and lived experience. Medi-Cal serves a broad population with varying needs, yet many enrollees experience barriers to accessing timely and high-quality care. These barriers contribute to poorer health outcomes and exacerbate existing differences across populations.

The Sacramento County Health Authority (SCHA) has identified several critical areas needing improvement: health care delivery, quality of care, timely access to services, and integration of care across providers. Additionally, there is a need to engage Medi-Cal enrollees more effectively to ensure their voices are heard in patient care improvement efforts. The county must also respond proactively to state initiatives like California Advancing and Innovating Medi-Cal (CalAIM), which aims to transform the Medi-Cal program by integrating services and addressing social determinants of health.

Addressing these challenges requires a comprehensive approach that includes robust data collection and analysis of primary and secondary data, community engagement, and strategic planning. The goal is to create a health care system that is equitable, efficient, and responsive to the needs of all Medi-Cal enrollees in Sacramento County.

NORC will provide consulting services to support SCHA in improving health care quality for all populations.

NORC at the University of Chicago (NORC) will support SCHA by conducting an environmental scan to understand the current state of health care services in Sacramento County. This scan will involve key informant interviews with county leadership, commission leadership, providers, and other state/county subject matter experts to identify opportunities and pain points related to quality, timely access, and integration of care. NORC will review data sources available from Medi-Cal managed care plans (MCPs) and other entities to assess data quality and make recommendations for metrics to track over time.

To engage Medi-Cal enrollees, NORC will conduct virtual focus groups and develop a survey to center their voices in patient care improvements. NORC will also support local efforts to respond to CalAIM and other key California Department of Health Care Services (DHCS) initiatives by analyzing data related to justice-involved populations, behavioral health, emergency department utilization rates, and homelessness. Throughout our work, NORC will be updating the SCHA and its subcommittees through regular attendance at their meetings.

NORC’s approach emphasizes the importance of disaggregating data to understand different populations and the compounded burden of differences in care quality and delivery across groups. By providing actionable insights and recommendations, NORC will help the SCHA enhance oversight and coordination of Medi-Cal MCPs, improve patient care, and reduce health differences.