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Quality


Contra Costa Health Plan's Quality Department is responsible for measuring and improving the quality of care provided to our members. We strive to provide services that are safe, effective, patient-centered, timely, efficient, and equitable.

Please see our Program Description for further information and the HEDIS report for tracking of some of the things we measure.


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. For more information, please email QualityConcerns@cchealth.org.

Initial Health Assessment (IHA) Tool Kit


Provider-Preventable Conditions (PPCs)

Provider Preventable Conditions (PPCs) consist of health care-acquired conditions (HCAC) when they occur in acute inpatient hospital settings only and other provider-preventable conditions (OPPC) when they occur in any health care settings.

Federal law requires that all providers report provider-preventable conditions (PPCs) that occurred during treatment of Medi-Cal patients. Providers must report all PPCs that are associated with claims for Medi-Cal payment or with courses of treatment given to a Medi-Cal patient for which payment would otherwise be available. Providers do not need to report PPCs that existed prior to the provider initiating treatment for the beneficiary.

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 no longer reimburse providers for PPCs that occur during treatment of Medi-Cal patients. CCHP will investigate all reports of PPCs discovers through any means to determine if payment adjustment is necessary.

Reporting Requirements

For CCHP Medi-Cal members, providers must report directly to CCHP using the PPC reporting form within five (5) business days of discovery of the PPC and confirmation that the patient is a Medi-Cal beneficiary.

The form can be completed online or downloaded here.

Please submit forms online or fax to:
CCHP Quality Department
Fax: 925-313-6870

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.