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: commercial HMO, commercial PPO, Medicaid managed care, and Child Health Plus. The Medicaid guides are also available in Spanish.

The Consumer Guides rate plans on ten domains of care (six for Child Health Plus). Plans are scored for each domain based on their standard score, and ranked on overall performance in each domain.

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 Managed Care Domains:

Child and Adolescent Care

  • Well-Child and Preventive Care Visits During the 3rd, 4th, 5th and 6th Years
  • Annual Dental Visit Ages 2-18 (Medicaid only)
  • Childhood Immunization
  • Lead Testing
  • Weight Assessment and Counseling for Children/Adolescents (Ages 3-17) - BMI
  • Immunizations for Adolescents - Combination 1

Women's Preventive Care

  • Cervical Cancer Screening
  • Breast Cancer Screening
  • Two Chlamydia Screening Measures (Ages 16-20, Ages 21-24)

Maternal Health

  • Postpartum Care
  • Timeliness of Prenatal Care
  • Frequency of Ongoing Prenatal Care (Medicaid Only)
  • Risk-Adjusted Low Birthweight *
  • Prenatal Care in the First Trimester *

* Due to differences in the data elements on birth certificates, New York City and Rest of State data is calculated separately for these measures. Plans operating both in and out of New York City will have their data separated and compared to regional rates. Star ratings are based on the data applicable to the region.

Adult Preventive Care

  • Colorectal Cancer Screening (Commercial Only)
  • Flu Shots for Adults (Ages 50-64)
  • Adult BMI Assessment
  • Medical Assistance with Smoking Cessation - Discussing Cessation Medications

Care for Respiratory Conditions

  • Medication Management for People with Asthma (Ages 5-18) 50%
  • Medication Management for People with Asthma (Ages 19-64) 50%
  • Use of Spirometry Testing in the Assessment and Diagnosis of COPD
  • Pharmacotherapy Management of COPD Exacerbation: Corticosteroid and Bronchodilator use

Diabetes Care

  • HgbA1c Testing (Commercial Only)
  • LDL-C Screening (Commercial Only)
  • Dilated Eye Exam (Commercial Only)
  • Medical Attention for Nephropathy (Commercial Only)
  • Diabetes Screening Composite (Medicaid Only; DOH calculated Measure)
  • Blood Pressure Control Below 140/90

Cardiovascular Care

  • Controlling High Blood Pressure
  • Persistence of Beta Blocker Treatment
  • 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:
  • Within 7 days after hospitalization
  • Within 30 days after hospitalization

Satisfaction with Adult Care

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

Satisfaction with Children's Care (Medicaid Only)

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

Child Health Plus Domains:

Infant and Toddler Care

  • Childhood Immunization - Combination 3
  • Lead Testing
  • Well-Child and Preventive Care Visits in the First 15 Months of Life (5 or more)

Preschool and Middle Childhood Care

  • Well-Child and Preventive Care Visits During the 3rd, 4th, 5th and 6th Years
  • Weight Assessment and Counseling for Children/Adolescents (Ages 3-11) - BMI
  • Weight Assessment and Counseling for Children/Adolescents (Ages 3-11) - Nutrition and Diet
  • Weight Assessment and Counseling for Children/Adolescents ( Ages 3-11) - Physical Activity

Adolescent Care

  • Immunizations for Adolescents - Combination 1
  • Weight Assessment and Counseling for Children/Adolescents (Ages 12-17) - BMI
  • Weight Assessment and Counseling for Children/Adolescents (Ages 12-17) - Nutrition and Diet
  • Weight Assessment and Counseling for Children/Adolescents (Ages 12-17) - Physical Activity

Dental Care

  • Annual Dental Visit Ages 2-18 years

Asthma Care

  • Medication Management for People with Asthma (Ages 5-18) 50%

Care of Common Cold and Sore Throat

  • Appropriate Treatment for Upper Respiratory Infection
  • Appropriate Testing for Children with Pharyngitis

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