About eQARR 2013

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, adult health, behavioral health, and satisfaction with care.

The data in eQARR 2013 reflects services and care delivered during 2012 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, commercial PPO and Medicaid populations. Child Health Plus populations currently do not have any national benchmarks.

QARR data is collected by health plans and the information is validated by a licensed organization. Only valid information is included in the data.

QARR also includes information collected from a national 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 Bureau of Vital Statistics. Perinatal health measures are from 2011, as that is the most recent data available.

Types of Insurance

Information on five types of managed care insurance is included in this report: Commercial HMO, Commercial PPO, Medicaid, HIV Special Needs Plan (SNP), and Child Health Plus.

Commercial HMO Individual or employer sponsored health insurance. This is a form of health insurance where a health plan contracts with a network of providers to provide care; the member selects a primary care provider to coordinate care; and referrals to some services or specialists may be required.
Commercial PPO Individual or employer sponsored health insurance. This is a form of health insurance where a health plan contracts with a network of providers to provide care; there is no primary care provider assignment; and referrals to some services or specialists are not usually required.
Medicaid Government sponsored health insurance. This is a form of health insurance where a health plan contracts with a network of providers to provide care; the member selects a primary care provider to coordinate care; and referrals to some services or specialists may be required. This includes people who are eligible for Medicaid managed care and Family Health Plus (NYS's expansion program for adults age 19 and older).
HIV Special Needs Plan (SNP) Government sponsored health insurance. This is a form of health insurance where a health plan contracts with a network of experienced HIV-service providers, HIV specialist PCPs, and a comprehensive model of case management. This includes people who are eligible for Medicaid managed care who are living with HIV/AIDS and their related children. These health plans are only available in New York City.
Child Health Plus Government sponsored health insurance, although individuals may pay part of premium for some eligibility levels. This is a form of health insurance where a health plan contracts with a network of providers to provide care; the member selects a primary care provider to coordinate care; and referrals to some services or specialists may be required. This is NYS's version of the federal State Children's Health Insurance Program (SCHIP) for people up to age 19.

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 2012 QARR measurement set include: Adolescent Preventive Care Measures, Childhood Immunization Status, Cholesterol Management for Patients with Cardiovascular Conditions, Colorectal Cancer Screening, Comprehensive Diabetes Care, Lead Screening in Children, Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents, and CAHPS Survey Data for Medicaid. Rates displayed for these measures are based upon services delivered during 2011.

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 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.

The results for HIV Special Needs Plans (SNP) are displayed under Medicaid Managed Care.

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

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, Adult Health, and 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. Results are collected for the following fields: family medicine, internal medicine, obstetrics and gynecology, and pediatrics. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
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. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
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?" (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
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?" (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)

Child and Adolescent Health

Adolescent Immunization-Combo
The percentage of members, age 13 years, who had one dose of meningococcal vaccine between their 11th and 13th birthdays and one dose of tetanus, diphtheria and pertussis vaccine between their 10th and their 13th birthdays. (Commercial HMO, Commercial PPO, Medicaid, Child Health Plus)
Childhood Immunization Status (Combo 3: 4-3-1-3-3-1-4)
The percentage of members, age 2 years, who were fully immunized. The HEDIS specifications for fully immunized consists 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 2012; 2011 data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, Child Health Plus)
Lead Testing
The percentage of members, age 2 years, who had their blood tested for lead poisoning at least once by their 2nd birthday. This measure was not collected for 2012; 2011 data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, Child Health Plus)
Well-Child & Preventive Care Visits in First 15 Months of Life (5+ Visits)
The percentage of children who had five or more well-child visits with a primary care provider in their first 15 months of life. (Commercial HMO, Commercial PPO, Medicaid, Child Health Plus)
Well-Child & Preventive Care Visits in 3rd, 4th, 5th & 6th Year of Life
The percentage of children, ages 3 to 6 years, who had one or more well-child visits with a primary care provider during the measurement year. (Commercial HMO, Commercial PPO, Medicaid, Child Health Plus)
Adolescent Well-Care Visits
The percentage of adolescents, ages 12 to 21 years, who had at least one comprehensive well-care visit with a primary care provider during the measurement year. (Commercial HMO, Commercial PPO, Medicaid, Child Health Plus)
Annual Dental Visit (Ages 2-18)
The percentage of children and adolescents, ages 2 to 18 years, who had at least one dental visit within the measurement year. (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 HMO, Commercial PPO, Medicaid, Child Health Plus)
Appropriate Testing for Pharyngitis
The percentage of children, ages 2 to 18 years, who were diagnosed with pharyngitis, were prescribed an antibiotic, and who were given a group A streptococcus test. (Commercial HMO, Commercial PPO, Medicaid, Child Health Plus)
Use of Appropriate Medications for People with Asthma (Ages 5-18)
The percentage of children, ages 5 to 18 years, with persistent asthma who received at least one appropriate medication to control their condition during the measurement year. (Commercial HMO, Commercial PPO, Medicaid, Child Health Plus)
Appropriate Asthma Medications- 3+ Controllers (Ages 5-18)
The percentage of children, ages 5 to 18 years, with persistent asthma who had three or more controller medication dispensing events in the last year. (Commercial HMO, Commercial PPO, Medicaid, Child Health Plus)
Medical Management for People with Asthma 50% Days Covered (Ages 5-18)
The percentage of children, ages 5 to 18 years, with persistent asthma who filled prescriptions for asthma controller medications during at least 50% of their treatment period. (Commercial HMO, Commercial PPO, 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, one of which was within 30 days of when the first ADHD medication was dispensed. There are two measures to assess follow-up care for children taking ADHD medication. (Commercial HMO, Commercial PPO, Medicaid, Child Health Plus)
  1. Initiation Phase: The percentage of children with a new prescription for ADHD medication and who had one follow-up visit with a practitioner within the 30 days after starting the medication. (Commercial HMO, Commercial PPO, Medicaid, Child Health Plus)
  2. Continuation & Maintenance Phase: The percentage of children with a new prescription for ADHD medication who remained on the medication for 7 months and who, in addition to the visit in the Initiation Phase, had at least 2 follow-up visits in the 9-month period after the initiation phase ended. (Commercial HMO, Commercial PPO, Medicaid, Child Health Plus)
Weight Assessment and Counseling for Nutrition and Physical Activity
The percentage of children and adolescents, ages 3 to 17 years, who had an outpatient visit with a PCP or OB/GYN practitioner during the measurement year, receiving the following three components of care during the measurement year. This measure was not collected for 2012; 2011 data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, Child Health Plus):
  1. BMI percentile
  2. Counseling for nutrition
  3. Counseling for physical activity
Adolescent Preventive Care
The percentage of adolescents, ages 12 to 17 years, who had at least one outpatient visit with a PCP or OB/GYN practitioner during the measurement year, and received the following four components of care during the measurement year. This measure was not collected for 2012; 2011 data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, Child Health Plus):
  1. Assessment or counseling or education on risk behaviors and preventive actions associated with sexual activity
  2. Assessment or counseling or education for depression
  3. Assessment or counseling or education about the risks of tobacco use
  4. Assessment or counseling or education about the risks of substance use (Substance use includes alcohol, street drugs, non-prescription drugs, prescription drug misuse and inhalant use)

Women's Health

Breast Cancer Screening
The percentage of women, ages 40 to 69 years, who had a mammogram during the measurement year or the year prior. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
Cervical Cancer Screening
The percentage of women, ages 24 to 64 years, who had a Pap test within the measurement year or the two years prior. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
Chlamydia Screening (Ages 16-24)
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 to 20 years and 21 to 24 years. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
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 HMO, Commercial PPO, Medicaid, HIV SNP)
Postpartum Care
The percentage of women who gave birth in the last year who had a postpartum care visit between 21 and 56 days after they gave birth. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
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, HIV SNP)
Perinatal Health
These measures reflect results of perinatal care for women who had a live birth during 2011. The results are calculated by the Office of Quality and Patient Safety using data from the health plans and from Vital Statistics. 2011 data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid)
  1. Prenatal Care in the First Trimester: The percentage of women continuously enrolled for 10 or more months who delivered a live birth and had their first prenatal care visit in the first trimester of pregnancy.
  2. 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. A low rate is desirable for this measure.
  3. Risk-Adjusted Primary Cesarean Delivery: The percentage of live infants born by cesarean delivery to women, continuously enrolled for 10 or more months, who had no prior cesarean deliveries. A low rate is desirable for this measure.
  4. Vaginal Birth After Cesarean Delivery: The percentage of women continuously enrolled for 10 or more months who delivered a live birth vaginally after having had a prior cesarean delivery.
*For more information about the risk-adjustment methodologies, please refer to the Technical Notes section.

Adult Health

Colon Cancer Screening
The percentage of adults, ages 50 to 75 years, who had appropriate screening for colorectal cancer. This measure was not collected for 2012; 2011 data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
Use of Imaging Studies for Low Back Pain
The percentage of members with a primary diagnosis of low back pain who did not have an imaging study (X-ray, MRI, CT scan). (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
Adult BMI Assessment
The percentage of members, ages 18 to 74 years, with an outpatient visit, who had their body mass index (BMI) documented during the measurement year or the year prior the measurement year. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
Annual Dental Visit (Ages 19-21)
The percentage of young adults, ages 19 to 21 years, who had at least one dental visit within the last year. (Medicaid)
Avoidance of Antibiotics Therapy in Adults with Acute Bronchitis
The percentage of adults, ages 18 to 64 years, with acute bronchitis who did NOT receive a prescription for antibiotics. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
Medical Assistance with Smoking Cessation
The percentage of members, ages 18 years and older, who are current smokers or tobacco users and who received medical information about smoking or tobacco use cessation within the last 12 months from a health care provider. This measure is collected as part of the CAHPS survey and is calculated as a two year rolling average. This measure was not collected for 2012 Medicaid; 2011 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
  1. Advising Smokers to Quit: The percentage of eligible adults who received cessation advice.
  2. Discussing Cessation Medications: The percentage of eligible adults who discussed or were recommended cessation medications.
  3. Discussing Cessation Strategies: The percentage of eligible adults who discussed or were provided cessation methods or strategies.
Flu Shot for Adults
The percentage of members, ages 50 to 64 years, who have had a flu shot. This measure is collected as part of the CAHPS survey and is calculated as a two year rolling average for commercial results. Medicaid results are based on a single year. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
Discussion of Aspirin Risks and Benefits
The percentage of men, ages 46 to 79 years, and women, ages 56 to 79 years, who discussed the risks and benefits of using aspirin with a doctor or health provider. This measure is collected as part of the CAHPS survey and is calculated as a two year rolling average for commercial results. (Commercial HMO, Commercial PPO)
Aspirin Use
The percentage of eligible members who are currently taking aspirin. Eligible members include: men, ages 46 to 65 years, with at least one cardiovascular risk factor; men, ages 66 to 79 years, regardless of risk factors; and women, ages 56 to 79 years, with at least two cardiovascular risk factors. This measure is collected as part of the CAHPS survey and is calculated as a two year rolling average for commercial results. (Commercial HMO, Commercial PPO)
Controlling High Blood Pressure
The percentage of members, ages 18 to 85 years, who have hypertension and whose blood pressure was adequately controlled (below 140/90). (Commercial HMO, Commercial PPO, Medicaid)
Cholesterol Management for Patients with Cardiovascular Conditions
The percentage of members, ages 18 to 75 years, with a cardiovascular condition, who had at least one cholesterol screening test and whose cholesterol level was below the recommended level (100 mg/dL) during the measurement year. This measure was not collected for 2012; 2011 data is presented in this report. There are two rates of cholesterol management as follows: (Commercial HMO, Commercial PPO, Medicaid)
  1. Cholesterol Screening: The percentage of members who had at least one LDL-C screening performed during the measurement year.
  2. Cholesterol Level Controlled (LDL-C < 100mg/dL): The percentage of members whose most recent LDL-C result during the measurement year was below 100mg/dL.
Persistence of Beta-Blocker Treatment
The percentage of members, age 18 years and older, who were hospitalized after a heart attack and received persistent beta-blocker treatment for six months after discharge. (Commercial HMO, Commercial PPO, Medicaid)
Use of Appropriate Medications for People with Asthma (Ages 19-64)
The percentage of members, ages 19 to 64 years, with persistent asthma who received at least one appropriate medication to control their condition during the measurement year. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
Appropriate Asthma Medications- 3+ Controllers (Ages 19-64)
The percentage of members, ages 19 to 64 years, with persistent asthma who had three or more controller medication dispensing events in the last year. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
Medical Management for People with Asthma 50% Days Covered (Ages 19-64)
The percentage of members, ages 19 to 64 years, with persistent asthma who filled prescriptions for asthma controller medications during at least 50% of their treatment period. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
The percentage of members, ages 40 years and older, with a new diagnosis of COPD or newly active COPD, who received spirometry testing to confirm the diagnosis. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
Pharmacotherapy Management of COPD Exacerbation
The percentage of COPD exacerbation events for members, ages 40 years and older, who have had an acute inpatient discharge or ED visit and who were dispensed appropriate medications to manage the exacerbation. This measure is presented as two separate rates. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
  1. Corticosteroid Rate: The percentage of events when the member was prescribed a systemic corticosteroid within 14 days of the event.
  2. Bronchodilator Rate: The percentage of events when the member was prescribed a bronchodilator within 30 days of the event.
Comprehensive Diabetes Care
This measure reports components of care for members, ages 18 to 75 years, with diabetes and the rate at which they received necessary components of diabetes care. Measures presented here are grouped into those that monitor diabetes and those that measure outcomes for diabetes. This measure was not collected for 2012; 2011 data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
  1. HbA1c Testing: The percentage of members with diabetes who received at least one Hemoglobin A1c (HbA1c) test within the past year.
  2. Lipid Profile: The percentage of members with diabetes who had at least one cholesterol screening test done during the past year.
  3. Dilated Eye Exam: The percentage of members with diabetes who had a retinal eye screening exam during the last year or who had a negative retinal exam in the year prior.
  4. Medical Attention for Nephropathy: The percentage of members with diabetes who had at least one nephropathy screening test or had evidence of nephropathy during the last year.
  5. Received All Four Tests: The percentage of members with diabetes who had at least one of each of the following: HbA1c test, cholesterol screening test, dilated eye exam, and medical attention for nephropathy. (Medicaid and HIV SNP only)
  6. 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.
  7. HbA1c Control: The percentage of members with diabetes whose most recent HbA1c level was <8.0 percent.
  8. HbA1c Control for Selected Populations: The percentage of members with diabetes whose most recent HbA1c level was <7.0 percent. Additional exclusion criteria are required for this indicator that will result in a different eligible population from all other indicators.
  9. Lipids Controlled: The percentage of members with diabetes whose most recent level of bad cholesterol was below the recommended level (LDL-C <100 mg/dL).
  10. Blood pressure controlled: The percentage of members with diabetes whose most recent blood pressure reading below 140/90.
  11. HbA1c and Lipids controlled: The percentage of members with diabetes whose most recent HbA1c level was at or less than 9.0 percent and whose most recent level of bad cholesterol was less than LDL-C <100 mg/dL. (Medicaid and HIV SNP only)
Drug Therapy for Rheumatoid Arthritis
The percentage of members with rheumatoid arthritis who were dispensed at least one ambulatory prescription for a disease modifying anti-rheumatic drug. (Commercial HMO, Commercial PPO, Medicaid)
Annual Monitoring for Patients on Persistent Medications
The percentage of members, ages 18 years and older, who were taking certain medications for at least six months and who received specific monitoring tests. The following rates specify categories of medications that are of interest: (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
  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 anticonvulsants for members who received at least a 180-day supply of an anticonvulsant and who had at least one blood test for therapeutic drug level for each anticonvulsant in the measurement year.
  5. The combined rate is the sum of the four numerators divided by the sum of the four denominators.
HIV/AIDS Comprehensive Care
These measures are quality indicators of recommended treatment and preventive care for people living with HIV/AIDS. (Medicaid, HIV SNP)
  1. Engaged in Care: The percentage of members with HIV/AIDS, ages 2 years and older, who had two visits for primary care or HIV related care with at least one visit during each half of the past year.
  2. Viral Load Monitoring: The percentage of members with HIV/AIDS, ages 2 years and older, who had two viral load tests performed with at least one test during each half of the past year.
  3. Syphilis Screening: The percentage of members with HIV/AIDS, ages 19 years and older, who were screened for syphilis in the past year.

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. There are two components for this measure. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
  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 and has two time-frame components. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
  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 for Adults

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. This measure was not collected for 2012 Medicaid; 2011 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
  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. This measure was not collected for 2012 Medicaid; 2011 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
  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 how, in the last 12 months, their health plan handled claims. The following questions are contained in this composite: (Commercial HMO, Commercial PPO)
  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 Cost
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 HMO, Commercial PPO)
  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. This measure was not collected for 2012 Medicaid; 2011 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
  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?
Rating of Health Plan
The percentage of members responding 8, 9 or 10 on a scale of 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible. This measure was not collected for 2012 Medicaid; 2011 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
Collaborative Decision Making
The percentage of members responding "definitely yes" when asked a set of questions to identify if, in the last 12 months, they made healthcare decisions with their doctor. This measure was not collected for 2012 Medicaid; 2011 Medicaid data is presented in this report. The following questions are contained in this composite: (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
  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 or 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. This measure was not collected for 2012 Medicaid; 2011 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
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. This measure was not collected for 2012 Medicaid; 2011 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
Rating of Overall Healthcare
The percentage 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. This measure was not collected for 2012 Medicaid; 2011 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP)
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. This measure was not collected for 2012 Medicaid; 2011 Medicaid data is presented in this report. (Medicaid, HIV SNP)
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. This measure was not collected for 2012 Medicaid; 2011 Medicaid data is presented in this report. (Medicaid, HIV SNP)

Satisfaction with Care for Children

Getting Care Needed for Children
The percentage of parents responding "usually" or "always" when asked a set of questions to identify if, in the last 6 months, their child received care they needed. (Medicaid and Child Health Plus combined)
  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 your child needed through your health plan?
Getting Care Quickly for Children
The percentage of parents responding "usually" or "always" when asked a set of questions to identify if, in the last 6 months, their child received health services quickly. (Medicaid and Child Health Plus combined)
  1. When your child needed care right away for an illness, injury, or condition, how often did your child get care as soon as you wanted?
  2. Not counting the times your child needed health care right away, how often did your child get an appointment for health care as soon as you wanted?
Access to Prescription Medicines for Children
The percentage of parents responding "usually" or "always" when asked how often in the past 6 months, it was easy to get prescription medicines for their child through the child's health plan. (Medicaid and Child Health Plus combined)

Access to Specialized Services for Children
The percentage of parents responding "usually" or "always" when asked a set of questions to identify, if, in the past 6 months, the child received the specialized services the child needed. (Medicaid and Child Health Plus combined)
  1. How often was it easy to get special medical equipment or devices for your child?
  2. How often was it easy to get physical, occupational, or speech therapy for your child?
  3. How often was it easy to get emotional, developmental, or behavioral treatment or counseling for your child?
Rating of Health Plan for Children
The percentage of parents 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. (Medicaid and Child Health Plus combined)
Customer Service for Children
The percentage of parents responding "usually" or "always" when asked a set of questions to identify if, in the last 6 months, they used their child's health plan's customer service. (Medicaid and Child Health Plus combined)
  1. How often did your child's health plan's customer service give you the information or help you needed?
  2. How often did your child's health plan's customer service staff treat you with courtesy and respect?
Collaborative Decision Making for Children
The percentage of parents responding "yes" when asked a set of questions to identify if, in the last 6 months, they made healthcare decisions with their child's doctor. The following questions are contained in this composite: (Medicaid and Child Health Plus combined)
  1. Did a doctor or other health provider talk with you about the pros and cons of each choice for your child's treatment or healthcare?
  2. When there was more than one choice for your child's treatment of healthcare, did a doctor or other health provider ask which choice was best for you?
Coordination of Care for Children with Chronic Conditions
The percentage of parents responding "yes" when asked a set of questions to identify if, in the last 6 months, they received needed healthcare coordination with daycare, school, or other healthcare providers. (Medicaid and Child Health Plus combined)
  1. Did you get the help you needed from your child's doctor or other health providers in contacting your child's school or daycare?
  2. Did anyone from your child's health plan, doctor's office or clinic help you coordinate your child's care among different providers or health care services?
Rating of Overall Healthcare for Children
The percentage of parents 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. (Medicaid and Child Health Plus combined)
Satisfaction with Personal Doctor for Children
The percentage of parents 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 child's personal doctor?" (Medicaid and Child Health Plus combined)
Satisfaction with Specialist for Children
The percentage of parents 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 the specialist your child sees most often?" (Medicaid and Child Health Plus combined)
Satisfaction with Provider Communication for Children
The percentage of parents 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. (Medicaid and Child Health Plus combined)
Family-Centered Care: Personal Doctor Who Knows Child
The percentage of parents responding "yes" when asked a set of questions to identify if, in the last 6 months, their child's doctor knew about the child's and family's daily living needs. The following questions are contained in this composite: (Medicaid and Child Health Plus combined)
  1. Did your child's personal doctor talk with you about how your child is feeling, growing, or behaving?
  2. Does your child's personal doctor understand how the child's medical, behavioral, or other health conditions affect your child's day-to-day life?
  3. Does your child's personal doctor understand how the child's medical, behavioral, or other health conditions affect your family's day-to-day life?

Other Related Managed Care Reports and Websites

  • The 2013 Health Plan Comparison Report: A report comparing quality and satisfaction performance results for health plans. This report represents Commercial HMO, Commercial PPO, Medicaid, HIV SNP, and Child Health Plus data results.
  • The 2013 Health Plan Service Use in New York State: (Coming soon!) A report on use of inpatient, emergency room, and other health services. This report contains data on Commercial HMO, Commercial PPO, Medicaid, HIV SNP, and Child Health Plus plan performance during 2012.
  • The 2013 Regional Consumer Guides: NYSDOH publishes six regional guides for Commercial HMO, Commercial PPO, Medicaid, HIV SNP, 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 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, please contact the Office of Quality & Patient Safety at (518)486-9012 or e-mail nysqarr@health.state.ny.us.