DOH Releases Third Annual Managed Care "Report Card"
QARR 1996 Report Looks at Three Year Trends
Albany, June 23, 1998 - The third annual report on the quality of health care delivered by managed care organizations in the state shows that, overall, New York's health plans are improving the quality of care provided to their members and have increased their ability to measure plan performance reliably and accurately, State Health Commissioner Barbara A. DeBuono, M.D., said today.
"Improving health care outcomes for all New Yorkers has been a priority of the Pataki administration," State Health Commissioner Barbara A. DeBuono, M.D., said. "This latest report, which looks at trends in managed care performance over a three year period, shows that New Yorkers who are enrolled in health plans are receiving an overall high standard of care. Statewide commercial rates compared favorably with national benchmarks and statewide Medicaid rates showed noticeable improvement from 1995 to 1996."
The 1996 Quality Assurance Reporting Requirements (QARR) report represents the most comprehensive report card for managed care in the nation. Produced in collaboration with 52 managed care organizations, managed care providers, and New York State, QARR 1996 provides quality measures that can be used by consumers to weigh how well health plans are performing, and as a quality improvement tool by the plans themselves. The Health Department uses QARR data to work with plans and providers to enhance the health care outcomes of managed care enrollees through performance feedback, quality improvement programs, technical assistance and highlighting of "best practices."
The 1996 report looks at performance trends for plans serving both commercial and Medicaid populations. Statewide rates for six Medicaid measures (immunizations, lead screening, well-child visits, cervical cancer screening and glycohemoglobin testing of diabetics) improved from 1995 to 1996 and the rate of mammography for Medicaid patients remained the same.
Although several commercial measures showed slight declines from 1995 rates, New York's commercial quality rates continued to meet or exceed national benchmarks such as those set by the National Committee on Quality Assurance or Healthy People 2000.
Among findings of the 1996 QARR report:
- 90 percent of commercial enrollees ages 20 to 44 and 91 percent of enrollees ages 45 to 64 had one or more visits to a health care practitioner during 1996 compared to a national rate of 86 percent and 88 percent, respectively;
- Among the Medicaid population, access to health care was highest among enrollees in the 25 months to 6 years and 65 and older age groups (77 percent each);
- 70 percent of women age 52 to 64 in commercial plans were receiving mammograms, an increase of two percent over 1995, and well above the Healthy People 2000 goal of 60 percent;
- 72 percent of women age 21 to 64 in commercial plans were receiving Pap tests, compared to the national benchmark of 70 percent.
- The rate of lead screening for two-year-olds in Medicaid managed care was 73 percent, a four percentage point improvement over the 1995 rate;
- Low birth weight, the third leading cause of death among newborns in the United States, affected 5.9 percent of infants born in commercial plans, slightly higher than the 1995 measure of 5.6 percent and the Healthy People 2000 goal of 5 percent; and
- 72 percent of children enrolled in commercial managed care plans were fully immunized, in 1996, a decrease partly attributable to a change in documentation requirements from 1995.
Three-year trends among commercial health plan enrollees show an increase in the number of women who are receiving early prenatal care, but a slight decrease in prenatal care utilization, overall. While mammography screening increased during this time period, the rate of cervical cancer screening dropped slightly, as documentation and reporting requirements were tightened. Nearly all Medicaid measures showed a positive trend.
"Thanks to continued improvement in both the quality and reliability of information submitted by health plans, we are able to offer consumers a comprehensive look at the state of managed care in New York," Dr. DeBuono said. "The report can help educate the public about how health plans are measuring and improving their quality of care, and will allow plans and purchasers of health care to gauge individual performances against industry standards. The result will be better health outcomes."
State health officials use QARR data in their ongoing monitoring of managed care plans, which includes annual on-site surveillance, external quality review and analysis of Medicaid encounter data. Health plans whose rates have dropped, or have remained low in both QARR reports, will be required to specify steps they are taking to address problems which are contributing to poor performance. Low rates may indicate either that the plan has difficulty providing required services, or lacks adequate systems to track service delivery.
The QARR report is the result of a process that begins with data collection and submission by managed care plans. The 1996 quality data were subjected to rigorous review and analysis and were validated by an independent auditor, the Island Peer Review Organization (IPRO). The audit strategy was developed for the State Health Department by the National Committee on Quality Assurance (NCQA), the credentialing body for managed care plans.
A total of 88 percent of the plans audited produced reliable and accurate performance data, a three percent increase over the 1994 report. The report does not include information from plans whose data were deemed unreliable as a result of the audit.