DOH Reports on 2007 Health Plan Performance

Medicaid, Child Health Plus Performing Higher

ALBANY, N.Y. (August 1, 2008) – Children enrolled in Medicaid and Child Health Plus are receiving more preventive and primary care, with a 20 percent increase in immunizations, and higher percentages of children being tested for lead poisoning and obesity, and more having annual dental exams.

"As the state steps up its efforts to enroll more uninsured children into Child Health Plus under the new eligibility rules, we can demonstrate that Medicaid and Child Health Plus are quality health insurance programs," Health Commissioner Richard F. Daines, M.D., said. "We hope these results will encourage parents to seek out Child Health Plus to provide their kids with good health insurance coverage."

Under the budget approved by Governor Paterson and the Legislature in April, eligibility for Child Health Plus will be expanded on September 1 to children whose families make 400 percent of federal poverty level, up from the current 250 percent level. Premiums are charged on a sliding scale, so that parents with higher incomes pay more for the coverage than parents with lower incomes. This implements the Governor's goal of making health insurance for children affordable for working parents whose employers do not cover dependents. (To enroll, call toll free 1-800-698-4543.)

In the new study, quality measures for Medicaid services for adults are improving in many areas as well, including a drop in the percentage of diabetics whose disease is in poor control and increases in the percentage of enrollees whose cholesterol levels are under control.

"This demonstrates that health plans can help patients manage their complicated chronic diseases," Commissioner Daines said. "Managing chronic disease on an outpatient basis is far better for patients than delaying needed screenings until they have health crises that require hospitalization. We are pleased to see that as needs of patients change, health plans in New York are acting to meet the new challenges. In particular, we are proud of the quality improvements in our public insurance plans, Medicaid and Child Health Plus."

This is the 14th year that the New York State Department of Health has collected performance data from health plans serving both commercially and publicly insured (Medicaid, Child Health Plus and Family Health Plus) adults and children. The 2007 data is part of the DOH's Quality Assurance Reporting Requirements (QARR), an annual collection of data and information from health plans licensed to operate in New York State. The measures were developed by the National Commission for Quality Assurance (NCQA) with several New York State specific measures added to address local health priorities.

Other notable QARR results include the following:

Chronic Care

  • The percentage of diabetics considered in poor control has decreased from 41 percent in 2000 to 28 percent in 2007 for commercial payers. The Medicaid rates have decreased from 52 percent to 34 percent over the same time period. For commercial payers, that is a reduction of 20,000 people; for Medicaid, it is a reduction of 15,000 people whose blood sugar test results indicate poor control.
  • Overall, rates for all diabetes care measures (eye exam, nephropathy screening, lipid profile, lipids controlled and blood pressure controlled) have risen steadily for the Medicaid population since NCQA introduced the measures in 1998 — demonstrating health plans' ability to successfully manage the chronic care needs of this vulnerable population.
  • Annual Monitoring of Patients with Persistent Medications demonstrated slightly higher performance of Medicaid plans compared to commercial plans. Medicaid members receiving ACE Inhibitor or ARB medications, which treat high blood pressure and heart failure, received the appropriate monitoring 85 percent compared to 81 percent of the time for similar members of commercial plans.
  • Cholesterol screening for Medicaid recipients with cardiovascular conditions increased from 73 percent to 89 percent between 2003 and 2007. The percentage of members with cardiovascular conditions who had their cholesterol in control (<100mg/dL) increased from 36 percent to 47 percent in the same time period.

Mental Health

  • Since 2000, the percentage of Medicaid recipients who had the recommended outpatient mental health visit within seven days of a hospitalization for mental illness has increased from 43 percent to 56 percent.

Women's Health

  • Between 2003 and 2007, the percentage of women aged 16-25 who were tested for Chlamydia increased from 37 percent to 48 percent for commercial enrollees and from 43 percent to 55 percent for Medicaid enrollees.

Children and Adolescent Preventive Care

  • Approximately 70 percent of children in Medicaid managed care are fully immunized with the recommended 19 vaccinations by 24 months of age (four DPT, three IPV, one MMR, three Hib, three Hep B, one Varicella, and four Pneumococcal). This is a 20 percent increase from 2005. The rates for children enrolled in commercial and Child Health Plus plans are 73 percent and 68 percent, respectively.
  • The number of Medicaid infants who received none of the recommended six well-child visits in the first 15 months of life decreased from 11.3 percent to 2.3 percent between 2000 and 2007. Based on 2007 enrollment data, this difference means that approximately 4,600 more babies had at least one well-child visit.
  • There was a large increase in the recommended measurement of Body Mass Index for adolescents in Medicaid managed care. The BMI measurement rate increased from 26 percent in 2005 to 61 percent in 2007. This increased performance means that for 2007, 33,109 more teenagers received BMI screening. Similar increases were seen for commercial and Child Health Plus adolescents as well.
  • Between 2000 and 2007 there were large increases in the Medicaid rates for annual dental visits (29 percent to 49 percent) and testing for lead poisoning (76 percent to 86 percent). Between 2003 and 2007 the percentage of children appropriately tested for Group A streptococcus prior to receiving and filling a prescription for antibiotics increased from 45 percent to 73 percent.
  • Medicaid and Child Health Plus rates for assessment or counseling and education of adolescents on exercise, sexual health, depression, tobacco and substance use were higher than commercial plans. For example, 76 percent of Medicaid and 72 percent of Child Health Plus adolescents received counseling about tobacco use, compared to 69 percent of adolescents enrolled in commercial plans.
  • For measures where commercial plans outperformed Medicaid and Child Health Plus, the differences continued to diminish in 2007, indicating a leveling of the playing field with respect to health care disparities. Rates for the measure Appropriate Medications for Asthma for children aged 5-17 were very close, with 95 percent of commercially insured children receiving recommended therapy, compared to 92 percent and 95 percent for Medicaid and Child Health Plus respectively.