About eQARR 2009

eQARR (Quality Assurance Reporting Requirements) was developed by the New York State Department of Health (NYSDOH) to enable consumers to evaluate the quality of health care services provided by New York State's managed care plans. Using eQARR, you can determine how well a health plan performed in the areas of provider network, child and adolescent health, women's health, adults living with illness, behavioral health, and satisfaction with care.

The data in eQARR 2009 reflects services and care delivered during 2008 unless otherwise specified (see perinatal health and rotation details below).

The Measures

QARR measures are largely adopted from the National Committee for Quality Assurance's (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) with New York State-specific measures added to address public health issues of particular importance in New York. When available, national averages (benchmarks) from NCQA are also included for the commercial HMO and Medicaid populations. Child Health Plus populations currently don't have any national benchmarks.

While in the past the HMO has been the dominant model for health coverage in the United States and New York, in recent years the popularity of HMOs has decreased in favor of Preferred Provider Organization (PPO) or Exclusive Provider Organization (EPO) model. A PPO/EPO is a form of health insurance where a plan contracts with a network of providers. However, unlike an HMO, members are able to freely access network services without the use of a primary care provider or referrals. In 2009, twelve plans submitted PPO/EPO data about the care provided to their members in 2008. As this is the first year collecting data from PPO/EPO entities, the results are shown only in aggregate with a comparison to the result for Commercial HMOs in New York State.

QARR also includes information collected from a nation al consumer satisfaction survey program called Consumer Assessment of Healthcare Providers and Systems (CAHPS®). CAHPS is collected every year for commercial adult enrollees. The NYSDOH sponsors a consumer satisfaction survey for Medicaid enrollees every two years.

The perinatal health measures are calculated by the New York State Department of Health using birth data submitted by the health plans and the Department's Vital Statistics file. Perinatal health measures are from 2007 as that is the most recent data available.

Rotation of Measures

Some services require more resource intensive methods of collection, and these measures are often rotated to control collection burden. When a measure is rotated for the reporting year, the data from the prior collection cycle is included. The measures which were not collected as part of the 2008 QARR measurement set include: Childhood Immunization, Lead Testing, Well-Child measures, Adolescent Well-Care visits, Cholesterol Management, Diabetes Care, Colorectal Cancer Screening, and CAHPS for Medicaid. Rates displayed for these measures are based upon services delivered during 2007.

Please note that the NYSDOH will not be reporting the Use of Imaging Studies for Low Back Pain measure for 2008 because of inconsistent specification interpretation and related coding concerns.

The Results

Plan-specific rates (percentages) are accompanied by a symbol to denote whether the plan's rate is statistically above (Significantly Better than the Statewide Average) or below (Significantly Worse than the Statewide Average) the statewide average.

When comparing plan rates and associated significance ratings, you may notice plans that have the same numerical rating but a different significance rating. While this may seem like an error, plan significance ratings are based on how much a plan's rate differs from the statewide average and the number of individuals included in the rate. Therefore, plans can have the same rate but have different significance ratings because their rates are based on different numbers of enrollees.

Regions of New York State

For the purposes of eQARR, the counties of New York State were grouped into the following six regions:

Long Island

  • Nassau
  • Suffolk

New York City

  • Bronx
  • Kings (Brooklyn)
  • New York (Manhattan)
  • Queens
  • Richmond (Staten Island)

Hudson Valley

  • Dutchess
  • Orange
  • Putnam
  • Rockland
  • Sullivan
  • Ulster
  • Westchester

Northeast

  • Albany
  • Clinton
  • Columbia
  • Delaware
  • Essex
  • Franklin
  • Fulton
  • Greene
  • Hamilton
  • Montgomery
  • Otsego
  • Rensselaer
  • Saratoga
  • Schenectady
  • Schoharie
  • Warren
  • Washington

Central

  • Broome
  • Cayuga
  • Chenango
  • Cortland
  • Herkimer
  • Jefferson
  • Lewis
  • Madison
  • Oneida
  • Onondaga
  • Oswego
  • St. Lawrence
  • Tioga
  • Tompkins

Western

  • Allegany
  • Cattaraugus
  • Chautauqua
  • Chemung
  • Erie
  • Genesee
  • Livingston
  • Monroe
  • Niagara
  • Ontario
  • Orleans
  • Schuyler
  • Seneca
  • Steuben
  • Wayne
  • Wyoming
  • Yates

Populations

Within each region, there is information for managed care enrollees in each of the following types of insurance: Commercial(CO), Medicaid (MA) and Child Health Plus (CHP). Individuals whose employers pay for their health insurance or who pay for their health insurance directly are in the commercial population. Medicaid and Child Health Plus are New York's public health insurance programs.

Family Health Plus is a public health insurance program for adults between the ages of 19 and 64 who do not have health insurance - either on their own or through their employers - but have incomes too high to qualify for Medicaid. Family Health Plus is available to single adults, couples without children, and parents who are residents of New York State and are United States citizens or fall under one of many immigration categories. Family Health Plus enrollees are included in the Medicaid percentages.

New York's Health Plans

eQARR contains information about managed care plans serving New York State residents including the counties and populations they serve on the Plan Profile Table. Customer Service telephone numbers are included along with their web sites. If you click on a plan's name, you will link to the plan's web site. Data from plans with low enrollment are not reported, but are included in the statewide average calculations.

Also included are NCQA accreditation ratings. NYSDOH does not require NCQA accreditation; the decision to seek NCQA accreditation is voluntary. NCQA ratings are the result of a comprehensive process conducted by a team of physicians and managed care experts. Plans are reviewed against more than 60 different standards designed to evaluate clinical and administrative systems related to such issues as customer service, confidentiality and consumer protection. Accreditation reviews occur throughout the year following this publication therefore changes may occur in ratings. For more information, see What Does NCQA Review When it Accredits an HMO?.

Domains

The measures in eQARR are divided into the following six domains. Information from the CAHPS consumer satisfaction survey is included in the Provider Network, Adults Living with Illness as well as in the Satisfaction with Care sections.

Provider Network

Board Certification
The percentage of physicians whose board certification is active as of December 31 of the measurement year in each of the following fields: family medicine, internal medicine, obstetrics and gynecology, and pediatrics. (Commercial, Medicaid)
Satisfaction with Provider Communication
The percentage of members who responded "usually" or "always" when asked how often their doctor listened to them carefully, explained things in a way they could understand, showed respect for what they had to say, and spent enough time with them. 2007 data is presented for Medicaid. (Commercial, Medicaid)
Satisfaction with Personal Doctor
The percentage of members responding 8, 9, or 10 (on a scale of 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor) when asked "How would you rate your personal doctor now?" 2007 data is presented for Medicaid. (Commercial, Medicaid)
Satisfaction with Specialist
The percentage of members responding 8, 9, or 10 (on a scale of 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible) when asked "How would you rate your specialist?" 2007 data is presented for Medicaid.(Commercial, Medicaid)

Child and Adolescent Health

Childhood Immunization (4-3-1-3-3-1-4)
The percentage of two-year olds who were fully immunized. The HEDIS specifications for fully immunized consisted of the following vaccines: 4 Diptheria/Tetanus/Pertussis, 3 Polio, 1 Measles/Mumps/Rubella, 3 H Influenza type B, 3 Hepatitis B, 1 Varicella, and 4 pneumococcal. This measure was not collected for 2008; 2007 data is presented in this report.(Commercial, Medicaid, Child Health Plus)
Lead Testing
The percentage of two-year olds that had their blood tested for lead poisoning at least once. This measure was not collected for 2008; 2007 data is presented in this report. (Commercial, Medicaid, Child Health Plus)
Well-Child and Preventive Care Visits in the First 15 Months of life
The percentage of children who had five or more well-child and preventive health visits in their first 15 months of life.This measure was not collected for 2008; 2007 data is presented in this report. (Commercial, Medicaid, Child Health Plus)
Well-Child and Preventive Care Visits During the 3rd, 4th, 5th and 6th Years
The percentage of children between the ages of three and six years who had a well-child and preventive health visit in the past year. This measure was not collected for 2008; 2007 data is presented in this report. (Commercial, Medicaid, Child Health Plus)
Adolescent Well Care and Preventive Visits
The percentage of adolescents (ages 12-21) who had a well-care or preventive care visit in the past year. This measure was not collected for 2008; 2007 data is presented in this report. (Commercial, Medicaid, Child Health Plus)
Annual Dental Visit
The percentage of children and adolescents ages 2 through 18 years, who had at least one dental visit within the last year. When a Medicaid plan does not offer dental care as part of its benefit package, enrollees have access to dental services through fee-for-service. (Medicaid, Child Health Plus)
Appropriate Treatment for Upper Respiratory Infection (URI)
The percentage of children, ages 3 months to 18 years, who were diagnosed with an upper respiratory infection (common cold) and who were NOT given a prescription for an antibiotic. A higher score indicates more appropriate treatment of children with URI. (Commercial, Medicaid, Child Health Plus)
Appropriate Testing for Pharyngitis
The percentage of children, ages two to 18 years, who were diagnosed with pharyngitis, were prescribed an antibiotic, and who were given a group A streptococcus test. (Commercial, Medicaid, Child Health Plus)
Use of Appropriate Medications for People with Asthma Ages 5-17
The percentage of children ages 5 to 17 years with persistent asthma who received appropriate medications to control their condition. For Child Health Plus, the reporting age group is 5 to 18 years. (Commercial, Medicaid, Child Health Plus)
Follow-Up Care for Children Prescribed ADHD Medication
The percentage of children, ages 6 to 12 years, who were newly prescribed ADHD medication and who had at least 3 follow-up visits within a 10-month period of taking the medication. There are two measures to assess follow-up care for children taking ADHD medication. (Commercial, Medicaid, Child Health Plus)
  1. Initiation Phase:The percentage of children ages 6 to 12 who were prescribed an ADHD medication and who had one follow-up visit with a practitioner, with prescribing authority, within the 30 days after starting the medication. (Commercial, Medicaid, Child Health Plus)
  2. Continuation Phase:The percentage of children ages 6 to 12 who were prescribed an ADHD medication and who had one follow-up visit with a practitioner with prescribing authority within the 30 days and at least two follow-up visits from 31-300 days after starting the medication. (Commercial, Medicaid, Child Health Plus)

Women's Health

Breast Cancer Screening
The percentage of women between the ages of 40 and 69 who had a mammogram during the measurement year or the year prior. (Commercial, Medicaid)
Cervical Cancer Screening
The percentage of women between the ages of 24 and 64 who had a Pap test within the measurement year or the two years prior. (Commercial, Medicaid)
Chlamydia Screening
The percentage of sexually active young women who had at least one test for Chlamydia during the measurement year. The measure is reported separately for ages 16 through 20 and 21 through 24. (Commercial, Medicaid)
Timeliness of Prenatal Care
The percentage of women who gave birth in the last year who had a prenatal care visit in their first trimester or within 42 days of enrollment in their health plan. (Commercial, Medicaid)
Postpartum Care
The percentage of women who had a postpartum care visit between 21 and 56 days after they gave birth. (Commercial, Medicaid)
Frequency of Ongoing Prenatal Care
The percentage of women who received 81 percent or more of the expected number of prenatal care visits, adjusted for gestational age and month the member enrolled in the health plan. (Medicaid)
Perinatal Health
These measures reflect results of perinatal care for women who had a live birth during 2007. The results are calculated by the Office of Health Insurance Programs using data from the health plans and from Vital Statistics. (Commercial, Medicaid)
  1. Risk-Adjusted Low Birthweight (LBW)*: The percentage of live infants weighing less than 2500 grams among all deliveries by women continuously enrolled in a plan for 10 or more months. 2007 data is presented in this report. A low rate is desirable for this measure.
  2. Prenatal Care in the First Trimester: The percentage of women continuously enrolled for 10 or more months who delivered a live birth between January 1, 2007 and December, 31 2007, and had their first prenatal care visit in their first trimester of pregnancy. 2007 data is presented in this report.
  3. LBW Births at Level II/III/IV Facilities: The percentage of low birthweight babies (<2500 g), born to women continuously enrolled for 10 or more months, who were delivered at Level II, III, or IV facilities. 2007 data is presented in this report.
*For more information about the risk-adjustment methodologies, please refer to the Technical Notes section

Adults Living With Illness

Colon Cancer Screening
The percentage of adults, ages 50 to 80 years, who had appropriate screening for colorectal cancer. This measure was not collected for 2008; 2007 data is presented in this report.(Commercial)
Annual Dental Visit
The percentage of adults ages 19 through 21 years, who had at least one dental visit within the last year. When a Medicaid plan does not offer dental care as part of its benefit package, enrollees have access to dental services through fee-for-service. (Medicaid)
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
The percentage of adults, ages 18 to 64, with acute bronchitis who did not receive a prescription for antibiotics. (Commercial, Medicaid)
Advising Smokers to Quit
The percentage of members, 18 years and older, who are current smokers, who received advice within the last year from a health care provider to quit smoking. 2007 data is presented for Medicaid. (Commercial, Medicaid)
Discussing Smoking Cessation Medications
The percentage of members, 18 years and older, who are current smokers, who discussed or were recommended smoking cessation medications by a health care provider. 2007 data is presented for Medicaid.(Commercial, Medicaid)
Discussing Smoking Cessation Strategies
The percentage of members, 18 years and older, who are current smokers, who discussed or were recommended smoking cessation methods or strategies by a health care provider. 2007 data is presented for Medicaid. (Commercial, Medicaid)
Flu Shot for Adults
The percentage of members, ages 50 to 64, who have had a flu shot. 2007 data is presented for Medicaid. (Commercial, Medicaid)
Controlling High Blood Pressure
The percentage of members, ages 18 to 85 years, who have hypertension and who have controlled their blood pressure (below 140/90).(Commercial, Medicaid)
Cholesterol Management for Patients with Cardiovascular Conditions
The percentage of members, who had a heart attack, or heart surgery, or heart related procedures in the last year, or have had a diagnosis of ischemic vascular disease within the past two years and received the following necessary components of Cholesterol management in the measurement year. This measure was not collected for 2008. 2007 data is presented in this report. (Commercial, Medicaid)
  1. Screening Test: The percentage of members who had a cholesterol screening test.
  2. Level Controlled (LDL-C < 100mg/dL): The percentage of members who had a cholesterol level LDL-C result of < 100mg/dL indicating the recommended level of control.
Persistence of Beta Blocker Use
The percentage of members, age 35 years and older, who were hospitalized after a heart attack and received persistent beta-blocker treatment. (Commercial)
Use of Appropriate Medications for People with Asthma Ages 18-56
The percentage of members, ages 18 to 56 years, with persistent asthma who received appropriate medication to control their condition. (Commercial, Medicaid)
Use of Appropriate Asthma Medications Ages 5-56 3+ Controllers
The percentage of members with persistent asthma who had three or more controller medication dispensing events in the last year. (Medicaid)
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
The percentage of members 40 years of age and older with a new diagnosis of COPD who received spirometry testing to confirm the diagnosis. (Commercial, Medicaid)
Pharmacotherapy Management of COPD Exacerbation
The percentage of times that members 40 years of age and older who have had an acute inpatient discharge or ED visit for COPD, received the two recommended types of medications to manage the exacerbation. This measure is presented as two separate rates.(Commercial, Medicaid)
  1. Corticosteroid Rate: The percentage of instances when the member was prescribed a systemic corticosteroid within 14 days of the event.
  2. Bronchodilator Rate: The percentage of instances when the member was prescribed a bronchodilator within 30 days of the event.
Comprehensive Diabetes Care
This measure reports components of care for members with diabetes and the rate at which they received necessary components of diabetes care. This measure was not collected for 2008; 2007 data is presented in this report.(Commercial, Medicaid)
  1. HbA1c Testing: The percentage of members with diabetes who received a Hemoglobin A1c (HbA1c) test within the past year.
  2. Poor HbA1c Control: The percentage of members with diabetes whose most recent HbA1c level indicated poor control ( >9.0 percent). A low rate is desirable for this measure.
  3. Lipid Profile: The percentage of members with diabetes who had a cholesterol test done over the past year.
  4. Lipids Controlled: The percentage of members with diabetes whose most recent level of bad cholesterol was in control (LDL-C <100 mg/dL).
  5. Blood pressure controlled: The percentage of members with diabetes who have controlled their blood pressure (below 130/80).
  6. Dilated Eye Exam: The percentage of members with diabetes who had a retinal eye screening exam over the last two years.
  7. Nephropathy Monitoring: The percentage of members with diabetes who were screened or monitored for kidney damage.
Drug Therapy for Rheumatoid Arthritis
The percentage of members with rheumatoid arthritis who were prescribed disease modifying anti-rheumatic drug therapy during the measurement year. (Commercial, Medicaid)
Annual Monitoring for Patients on Persistent Medications
The percentage of members 18 years and older who were taking certain medications for at least six months and who received specific monitoring tests. The following numerators specify categories of medications that are of interest: (Commercial, Medicaid)
  1. The percentage of members who received at least a 180 day supply of ACE inhibitors and/or ARBs, and who had at least one blood test for potassium and a monitoring test for kidney function in the measurement year.
  2. The percentage of members who received at least a 180 day supply of digoxin, and who had at least one blood test for potassium and a monitoring test for kidney function in the measurement year.
  3. The percentage of members who received at least a 180 day supply of diuretics, and who had at least one blood test for potassium and a monitoring test for kidney function in the measurement year.
  4. The percentage of members who received at least a 180 day supply of an anticonvulsant and who had at least one blood test for therapeutic drug level in the measurement year.
  5. The combined rate is the sum of the four numerators divided by the sum of the four denominators.

Behavioral Health

Antidepressant Medication Management
This measure is for members ages 18 years and older who were diagnosed with depression and treated with an antidepressant medication and has two components of care. (Commercial, Medicaid)
  1. Effective Acute Phase Treatment: The percentage of members who remained on antidepressant medication during the entire 12-week acute treatment phase.
  2. Effective Continuation Phase Treatment: The percentage of members who remained on antidepressant medication for at least six months.
Follow-up After Hospitalization for Mental Illness
This measure is for members ages 6 years and older who were hospitalized for treatment of selected mental health disorders (such as depression or bipolar disorder) and has two time-frame components. (Commercial, Medicaid)
  1. Within 7 Days: The percentage of members who were seen on an ambulatory basis or who were in intermediate treatment with a mental health provider within 7 days of discharge.
  2. Within 30 Days: The percentage of members who were seen on an ambulatory basis or who were in intermediate treatment with a mental health provider within 30 days of discharge.

Satisfaction with Care

Getting Care Needed
The percentage of members responding "usually or "always" when asked a set of questions to identify if, in the last 12 months, they received care they needed. 2007 data is presented for Medicaid. (Commercial, Medicaid)
  1. How often was it easy to get appointments with specialists?
  2. How often was it easy to get the care, tests, or treatment you thought you needed through your health plan?
Getting Care Quickly
The percentage of members responding "usually" or "always" when asked a set of questions to identify, if, in the last 12 months, they received health services quickly. 2007 data is presented for Medicaid. (Commercial, Medicaid)
  1. When you needed care right away for an illness, injury, or condition, how often did you get care as soon as you wanted?
  2. Not counting the times you needed health care right away, how often did you get an appointment for health care as soon as you wanted?
Claims Processing
The percentage of members responding "usually" or "always" when asked a set of questions to identify if, in the last 12 months, they submitted claims to their health plan. The following questions are contained in this composite: (Commercial)
  1. How often did your health plan handle your claims quickly?
  2. How often did your health plan handle your claims correctly?
Plan Information on Costs
The percentage of members responding "usually" or "always" when asked a set of questions to identify if, in the last 12 months, they looked for information about health care costs. The following questions are contained in this composite: (Commercial)
  1. How often were you able to find out from your health plan how much you would have to pay for a health care service or treatment?
  2. How often were you able to find out from your health plan how much you would have to pay for specific prescription medicines?
Customer Service
The percentage of members responding "usually or "always" when asked a set of questions to identify if, in the last 12 months, they used their health plan's customer service. 2007 data is presented for Medicaid. (Commercial, Medicaid)
  1. How often did your health plan's customer service give you the information or help you needed?
  2. How often did your health plan's customer service staff treat you with courtesy and respect?
  3. How often were the forms from your health plan easy to fill out? (Commercial only)
*Please note that NYSDOH calculates rates for this question differently than NCQA; therefore, rates for commercial plans may differ from other publications of this information.
Rating of Health Plan
The proportion of members responding 8, 9 or 10 on scale of 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible. 2007 data is presented for Medicaid. (Commercial, Medicaid)
Shared Decision Making
The percentage of members responding "definitely yes" or "somewhat yes" when asked a set of questions to identify if, in the last 12 months, they made healthcare decisions with their doctor. The following questions are contained in this composite: (Commercial)
  1. Did a doctor or other health provider talk with you about the pros and cons of each choice for your treatment or healthcare?
  2. When there was more than one choice for your treatment of healthcare, did a doctor or other health provider ask which choice was best for you?
Care Coordination
The percentage who responded "usually" or "always" when asked how often their personal doctor seemed informed and up-to-date about care they received from other doctors or health providers. 2007 data is presented for Medicaid. (Commercial, Medicaid)
Wellness Discussion
The percentage who responded "usually" or "always" when asked how often their doctor or other health provider discussed things to do to prevent illness. 2007 data is presented for Medicaid. (Commercial, Medicaid)
Rating of Overall Healthcare
The proportion of members responding 8, 9 or 10 on scale of 0 to 10, where 0 is the worst healthcare possible and 10 is the best healthcare possible. 2007 data is presented for Medicaid. (Commercial, Medicaid)
Getting Needed Counseling or Treatment
The percentage who responded "usually" or "always" when asked how often, in the past 6 months, it was easy to get counseling or treatment for a personal or family problem through their health plan. 2007 data is presented for Medicaid. (Medicaid)
Rating of Counseling or Treatment
The percentage of members responding 8, 9, or 10 on a scale of 0 to 10, where 0 is the worst counseling or treatment possible and 10 is the best counseling or treatment possible. 2007 data is presented for Medicaid. (Medicaid)

Other Related Managed Care Reports and Websites

  • The 2009 Report on Managed Care Performance :(Coming soon!) A Report on Quality, Satisfaction with Care and Consumer Satisfaction is a NYSDOH publication of provider network, access to care, quality of care and consumer satisfaction plan performance during 2008. This report represents commercial, Medicaid and Child Health Plus data results.
  • The 2009 Managed Care Utilization and Access Report : (Coming soon!)A NYSDOH report which contains information about access to care, and use of services, such as inpatient and outpatient care rates. This report contains data on commercial, Medicaid and Child Health Plus plan performance during 2008.
  • A Consumer's Guide to Managed Care :(Coming soon!) NYSDOH publishes six regional guides for commercial, Medicaid, and Child Health Plus Managed Care. The Consumer Guides rate plans on domains of care and measures of consumer satisfaction. Plans are ranked based upon performance in all areas. The New York City, Long Island and Western Medicaid guides are also available in Spanish.

Need More Information

If you have any questions or comments about eQARR or would like copies of the Consumer Guides or the 2009 Report on Managed Care Performance, please contact the Division of Quality & Evaluation at (518)486-9012 or e-mail nysqarr@health.state.ny.us.