Newsom Admin’s Bad Job of Collecting Mandated Statewide Drug Treatment Outcome Data

California collects statewide drug treatment outcome data through the California Outcomes Measurement System for Treatment (CalOMS Tx), administered by the Department of Health Care Services (DHCS). However, there are documented shortcomings in how this data is leveraged for accountability, performance improvement, or transparent public reporting on treatment effectiveness—issues that predate and continue under Governor Newsom’s administration. 

What Data Exists

California Outcomes Measurement System for Treatment requires providers receiving public funding (e.g. Drug Medi-Cal) to submit client-level data on admissions, discharges, services, substance use, employment, housing, criminal justice involvement, and other outcomes. It’s been the primary system for years and supplements other reporting like the Drug and Alcohol Treatment Access Report (DATAR).

Related efforts include performance measures under Drug Medi-Cal Organized Delivery System (DMC-ODS), such as treatment initiation/engagement rates, ASAM level-of-care matching, follow-up after discharge, and patient satisfaction surveys (often showing high ratings, e.g., 93% positive in some DMC-ODS data).

Broader behavioral health transformation and CalAIM initiatives are phasing in more measures, including health equity and access metrics. CalAIM is a series of initiatives and reforms to improve Medi-Cal quality and reduce health disparities in California.

Criticisms and Limitations Stakeholder reports and analyses highlight that while data is collected, it falls short on use and impact:

• CalOMS data “has yet to be used for accountability purposes.” Limited incentives for providers lead to “checking off boxes” rather than driving quality or outcomes, according to a 2024 report by Health Management Associates, Inc. HMA found that “the substance use disorder treatment system, which sits outside of specialty mental health and mild-to-moderate mental health services, results in an inconsistent and siloed system. The delivery of programs and services across the state vary because of differences in geography (rural, suburban, and urban densities) as well as county participation in the Drug Medi-Cal Organized Delivery System (DMC-ODS). This landscape analysis provides a deeper exploration into the challenges and opportunities specific to addressing substance use disorder.”
• Challenges include data silos, 42 CFR Part 2 privacy rules hindering integration with physical/mental health records, lack of a robust statewide EHR exchange for SUD, and difficulties linking inputs to long-term results (e.g., sustained recovery, reduced overdoses).
• The 2024 stakeholder report on substance use disorders in California noted needs for better data transparency, value-based incentives, and using metrics beyond basic reporting to improve care.

A 2023 State Auditor report on treatment facilities criticized DHCS oversight on licensing, inspections, and complaints, and note limitations in measuring effectiveness via available surveys. Many don’t cover licensed residential outcomes well or track post-treatment results.

The State Auditor reported that “Health Care Services investigates complaints about treatment facilities; however, we found that it is not always timely in completing these investigations. Specifically, although required to assign a complaint to an investigator within 10 days, Health Care Services frequently does not assign complaints on time. We found that it took Health Care Services an average of 183 days to assign the complaints when it did not meet its 10-day required time frame.”

Additionally, the audit found that “the department’s internal guidelines generally identify that investigative reports must be submitted by the analyst to a supervisor within 30 to 60 days. However, we found that it took Health Care Services analysts nearly one year on average to submit investigative reports for low‑ and medium‑priority complaints. Health Care Services completed high‑priority investigations, such as those relating to resident deaths, within an average of less than three months but still did not meet its guidelines. When Health Care Services does not complete an investigation in a timely manner, deficiencies may go unaddressed for significant periods.”