Regional Consumer Guide Domains

A Consumer's Guide to Managed Care

The NYS Department of Health publishes six regional guides for each type of insurance: 1) commercial HMO, 2) commercial PPO, and 3) Medicaid managed care and Child Health Plus. The Medicaid and Child Health Plus guides are also available in Spanish and can be requested at nysqarr@health.ny.gov.

The Consumer Guides rate plans on ten domains of care. Plans are scored based on their standardized score performance for measures in the domain, and the overall quality rating represents the performance for the plan across domains.

The measures used in this guide represent some, but not all of the measures collected from health plans through NYS Quality Assurance Reporting Requirements (QARR). For additional information about the individual measures used in each category, as well as, the other quality of care measures available, please see the New York State Department of Health's website.

The following describes the measures in each domain of care:

Commerical HMO, Commerical PPO, and Medicaid and Child Health Plus Managed Care Domains:

Child and Adolescent Care

  • Well Child Visit in the First 15 Months
  • Well Child and Preventive Care Visits During the 3rd, 4th, 5th and 6th Years
  • Annual Dental Visit 2-18 Year Olds (Medicaid and CHP only)
  • Childhood Immunization - Combination 3
  • Lead Testing
  • Appropriate Testing for Children with Pharyngitis
  • Appropriate Treatment for Children with Upper Respiratory Infection
  • Weight Assessment and Counseling for Children/Adolescents (3-17 Year Olds) - BMI,Nutrition or Physical Activity (Composite)
  • Adolescent Preventive Care -Depression
  • Immunizations for Adolescents - Combination 1

Women's Preventive Care

  • Breast Cancer Screening
  • Chlamydia 16-20 Year Olds
  • Chlamydia 21-24 Year Olds

Maternal Health

  • Postpartum Care
  • Timeliness of Prenatal Care
  • Frequency of Ongoing Prenatal Care (81%+, Medicaid Only)
  • Risk-Adjusted Low Birth Weight
  • Prenatal Care in the First Trimester

Adult Care

  • Colorectal Cancer Screening
  • Flu Shots for Adults
  • Adult BMI Assessment
  • Medical Assistance with Smoking Cessation - Discussing Cessation Medications
  • Use of Imaging Studies for Low Back Pain
  • Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis

Care for Respiratory Conditions

  • Medication Manment for People with Asthma (Ages 5-64) 75%
  • Medication Management for People with Asthma (Ages 5-64) 50%
  • Use of Spirometry Testing in the Assessment and Diagnosis of COPD
  • Use of Spirometry for COPD
  • Pharmacotherapy - Exacerbation COPD Corticosteroids in 14 days
  • Pharmacotherapy - Exacerbation COPD Bronchodilator in 30 days

Diabetes Care

  • Diabetes Screening Composite Received All 4 Tests ( DOH calculated Measure)
  • Blood Pressure Control Below 140/90
  • HbA1c Control < 8%

Cardiovascular Care

  • Controlling High Blood Pressure
  • Persistence of Beta Blocker Treatment
  • Discussion of Aspirin Risks and Benefits
  • Cholesterol Management Control - less than 100mg/dL
  • Annual Monitoring for Patients on Persistent Medications: ACE Inhibitor/ARB
  • Annual Monitoring for Patients on Persistent Medications: Diuretic

Mental Health

  • Follow-Up After Hospitalization for Mental Illness-7 days
  • Follow-Up After Hospitalization for Mental Illness-30 days
  • Antidepressant Medication Management-84 days
  • Antidepressant Medication Management-180 days
  • Follow-Up Care for Children Prescribed ADHD Medication-Initiation
  • Follow-Up Care for Children Prescribed ADHD Medication-Continuation
  • Adherence to Antipsychotic Medications for People with Schizophrenia (Medicaid Only)

Satisfaction with Adult Care

  • Rating of Doctor
  • Getting Care Needed
  • Rating of Health Plan
  • Rating of Specialist
  • Rating of Health Care

Satisfaction with Children's Care (Medicaid and Child Health Plus Only)

  • Rating of Doctor
  • Getting Care Needed
  • Rating of Health Plan
  • Rating of Specialist
  • Rating of Health Care

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