DOH Releases Fourth Annual Managed Care Report
QARR 1997 Report Includes New Performance Measures
Albany, May 12, 1999 --- Acting State Health Commissioner Dennis P. Whalen today released the fourth annual report of managed care performance in New York State showing that health plans, overall, are continuing to improve the quality of care provided to New Yorkers, and are submitting performance data that is more accurate and timely.
"Under Governor Pataki's leadership, New York is leading the nation in providing consumer protections for New Yorkers in need of quality care. The new QARR report includes benchmarks that will help New Yorkers examine managed care performance in several key areas and compare an individual plan with others," Acting Commissioner Whalen said. "Perhaps even more important, the report serves as a powerful incentive for managed care organizations to monitor and improve their own performance."
The 1997 Quality Assurance Reporting Requirements (QARR) report - the fourth released to date - 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 1997 provides quality measures that can be used by consumers and purchasers to weigh how well health plans are performing, and as a quality improvement tool by the plans themselves. The report contains significant new consumer information, including mental health and chemical dependency data, consumer satisfaction data, and "Effectiveness of Care" measurements, that among other things, track care provided to more chronically-ill plan members.
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.
"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," the Acting Commissioner said. "This report will permit plans and purchasers of managed care to gauge individual plan performance against industry standards and produce better health outcomes."
The report shows that Medicaid has improved over 1996 statewide rates in six measures (immunizations, substance abuse counseling, screening for cervical and breast cancers, diabetic monitoring and post hospitalization care for the mentally ill). It also shows that although several commercial measures had slight declines from 1996 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.
The QARR report shows that the gap between Medicaid rates and commercial plans has continued to narrow, specifically in measures like immunizations for two year-olds. The statewide rate for certain benchmarks ("Lead Screening" and "Access to Facilities for High Risk Deliveries") was higher in 1997 for Medicaid than commercial populations, and in some other categories ("Percent of Physicians who are Board-certified" and "Percent of Specialists who are Board-certified"), rates were the same.
Among findings of the 1997 QARR report:
- 91 percent of commercial enrollees ages 20 to 44 and 92 percent of enrollees ages 45 to 64 had one or more visits to a health care practitioner during 1997 compared to a national rate of 87 percent and 89 percent, respectively;
- 59 percent of commercial enrollees are "very" or "completely" satisfied with their current health plan, and 87 percent would recommend it to family members or friends;
- Among the Medicaid population, access to health care was highest among enrollees ages 12-24 months (78 percent) and 45-64 years (76 percent);
- 72 percent of women age 52 to 64 in commercial plans were receiving mammograms, an increase of two percent over 1996, equaling the National Committee on Quality Assurance (NCQA) Quality Compass rate and significantly exceeding the Healthy People 2000 goal of 60 percent;
- Use of appropriate asthma medications improved significantly over previous evaluations conducted by the Department in 1996; and
- 70 percent of children enrolled in commercial managed care plans were fully immunized, in 1997, compared to 64 percent from NCQA Quality Compass rate. In Medicaid, 64 percent of children in the plans were fully immunized compared to 56 percent in 1996.
The commercial satisfaction measure and commercial lead screening rate were new performance measures in 1997, as was the tracking of medication for people with asthma and HIV testing of pregnant women.
The QARR report is the result of a process that begins with data collection and submission by managed care plans. The 1997 quality data were subjected to rigorous review and analysis. All plans are audited on at least three quality measures. In order to pass the audit, they must show sufficient documentation (based on a random sample of charts) to verify that services were provided. The data in the report was validated by an independent auditor, the Island Peer Review Organization (IPRO). Health plans whose rates have dropped, or have remained low in past QARR reports, will be required to submit a corrective action plan to address the problems which are contributing to their poor performance. That plan will be used as a reference point by the Department during its annual onsite visits.
The 1997 QARR report will be distributed to consumers, libraries, business groups, local health departments and social service agencies, among others. It will available shortly through the State Health Department's web site on the Internet, http://www.health.state.ny.us5/12/99-51 OPA