State Health Commissioner Novello Releases 2005 Report on Managed Care Health Plan Performance

New York Health Plans Lead the Nation in Performance and Consumer Satisfaction

ALBANY, October 12, 2005 - State Health Commissioner Antonia C. Novello, M.D., M.P.H., Dr.P.H. today released the 2005 Quality Assurance Reporting Requirement (QARR) data on managed care performance in New York State. The QAAR report shows that health plans continue to rate among the best in the nation in the quality of care provided to New Yorkers through Medicaid Managed Care, Child Health Plus and private commercial insurance. This year's report is based on 2004 quality data.

The 2005 electronic version of the QARR Report known as 'eQARR' is available on the Department's web site at www.health.ny.gov. Overall, the report highlights demonstrate that more patients in managed care are satisfied with the care they receive from doctors; more pregnant women are accessing prenatal care; and a higher number of patients with diabetes are accessing comprehensive care from physicians to help them better manage and control their chronic illness.

"The information provided in the report is a clear indication that Governor Pataki's health care programs are working. Not only do New Yorkers have access to the best health care system in the nation, but by reviewing this report they are able to make well-informed decisions on which health plans and services are best for them," Dr. Novello said.

New York's commercial plans exceed the most recent comparable national benchmarks in 23 measures of quality including all measures of asthma and diabetes care. On average, commercial enrollees also rated their health plan higher than the national average. For Medicaid, New York exceeded national averages in 21 comparable measures of quality showing large differences in women's, perinatal and diabetes care, outpatient visits for depression and follow-up care to hospitalization for mental illness.

In addition, a recent report by the National Committee for Quality Assurance and U.S. News and World Report (The State of Health Care Quality 2005) indicates that New York has six of the top 20 commercial managed care plans in the country and five of the top 20 Medicaid plans. More information on "America's Best Health Plans" can be found at www.usnews.com.

The eQARR report contains valuable information for New York's consumers on health plan performance in a variety of areas including child and adolescent care, women's health care, adults living with chronic illness, behavioral health, diabetes care, satisfaction with care, access to care and provider network qualifications. Certain clinical areas, such as diabetes care for Medicaid enrollees, have on average shown large improvements. Although for certain measures there is little variability among plans, other measures reveal significant differences between high and low performing plans. Noteworthy results are indicated below.

Highlights of the 2005 eQARR report:

Child and Adolescent Care

  • The percent of children with asthma between the ages of 5 and 17 who received appropriate medications increased from 58 percent in 2002 to 69 percent in 2004.
  • Seventy one percent of children between the ages of three and six in Medicaid managed care received a 'well child' visit.

Women's Health

  • Ninety two percent of the women participating in commercial managed care received prenatal care in a timely manner, up from 88 percent in 2002. For Medicaid, women received timely prenatal care 84 percent of the time, up from 78 percent in 2002.
  • Postpartum visit rates rose to 78 percent in 2004, an increase from 74 percent in 2002 for women enrolled in commercial managed care plans. For Medicaid, the postpartum visit rate rose to 68 percent in 2004, up from 63 percent in 2002.

Comprehensive Diabetes Care

  • Ninety four percent of diabetics enrolled in commercial managed care had a cholesterol test done in the past two years; 87 percent had their blood-sugar levels tested in 2004.

Adults Living With Illness

  • Seventy two percent of Medicaid managed care enrollees with persistent asthma, who were between the ages of 18 and 56, received appropriate medication to control and treat asthma in 2004. This rate increased from 66 percent in 2001.

Behavioral Health

  • Sixty one percent of commercial managed care enrollees, who were newly diagnosed with depression and were treated with antidepressant medication, stayed on their medication after 84 days; 44 percent continued to take their medications after six months.

Access to Care

  • Ninety seven percent of children between the ages of 12 and 24 months, who were enrolled in commercial managed care, had a primary care visit with their provider during 2004. Every plan's rate was at least 90 percent.
  • Ninety one percent of Medicaid managed care children between the ages of 12 and 24 months had a doctor's visit.
  • The percentage of Child Health Plus enrollees between the ages of 7 and 11 who had a primary care visit increased from 89 to 94 percent between 2002 and 2004. Nineteen plans had rates over 90 percent.

Satisfaction with Care

  • Eighty percent of commercial members responded usually or always when asked a set of questions to identify if they received health plan services quickly.
  • Seventy eight percent of commercial members rated their primary care provider with an 8, 9 or 10 (on a scale of 0-10, where 0 is the worst possible doctor or nurse and 10 is the best possible doctor or nurse).

Health plan results are available by organization and are grouped into six regions of New York State, including: Central; Hudson Valley; Long Island; New York City; Northeast; and Western. By accessing a region, information can be obtained for the commercial, Medicaid or Child Health Plus plans providing services in that region and the counties within it. The 2005 report shows that New Yorkers in these plans continue to receive health care services at rates above the national average. The report is also used as a quality improvement tool by health plans in New York State.

The State's annual QARR Report is distributed to health plans, libraries, business groups, local health departments and social service agencies, among others.