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

New Measures Check on Obesity and Asthma Care; More Organizations Included

ALBANY, N.Y. (Oct. 9, 2009) – About half of all New Yorkers get their medical care through a health maintenance organization – an HMO – and a new report from the State Department of Health shows they are getting excellent care.

"While managed care sometimes gets a bad rap, both Medicaid and commercial managed care providers in New York are meeting high standards and consumers know it," said State Health Commissioner Richard F. Daines, M.D. "The Health Department measures how often the basics of health care are provided, how comprehensive the care is in several key areas, and how satisfied patients are with the quality of their care. The data show that member satisfaction and comprehensive, ongoing care are both rising, an excellent sign for those New Yorkers who trust their health care to managed care plans."

Managed care plans in New York continue to increase their members' satisfaction and provide comprehensive health care in areas from early prenatal care, continual care for high blood pressure and persistent asthma, to implementing new measures that assess weight control, according to the 2009 Quality Assurance Reporting Requirement (QARR) data on managed care performance in New York State.

The QAAR report – the 15th released to date - demonstrates that more patients in managed care are satisfied with the care they receive from doctors; more pregnant women are accessing early prenatal care; and a number of patients with high blood pressure are accessing comprehensive care from physicians to help them better manage and control their illness.

"This report offers consumers a comprehensive look at the state of managed care in New York," said Commissioner Daines. "If you're shopping for a managed care plan, this report will provide facts that could help guide your decision. It also serves as a powerful tool for managed care organizations to monitor and improve their own performance."

The 2009 electronic version of the QARR Report, known as "eQARR," is available on the Department's Web site at Produced in collaboration with managed care organizations, managed care providers and New York State, the report provides quality measures that consumers can use to weigh how well health plans are performing, and that health plans themselves can use as a quality improvement tool. The report contains several significant new performance measures that were adopted for the 2008 measurement year, including Adult Body Mass Index Assessment; appropriate asthma medications dispensing (commercial and Child Health Plus); HIV/AIDS Comprehensive Care; and Weight Assessment & Counseling for Nutrition & Physical Activity for Children and Adolescents.

The report illustrates that New York Medicaid has improved over 2008 statewide rates in 31 measures. Although several commercial measures had slight declines from 2008 rates, New York's commercial quality rates continued to meet or exceed national benchmarks, the report shows.

Highlights of the 2009 eQARR include:

New to QARR in 2009

  • In 2008, a new performance measure for members with persistent asthma was introduced in New York State. While the rates of people with asthma receiving one controller medication prescription remain high for all products (above 90 percent), data were collected this year on people with asthma who received three or more dispensing events of appropriate asthma medications. Medicaid Managed Care (MMC) members' rate of 77 percent compared to 81 percent for both commercial HMO and preferred provider organizations. Child Health Plus members received three or more dispensing events 80 percent of the time.
  • Obesity issues were the impetus for the addition of two new measures to the national data set for 2008. Adult Body Mass Index (BMI) Assessment is a reliable measure for weight, and this indicator calculates the percentage of adults having a BMI calculation at least once in the past two years. First-year results indicated 40 percent of commercial HMO and 45 percent of Medicaid insured enrollees had a BMI calculated. Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents, which contains three indicators, was also introduced into the National Committee for Quality Assurance's (NCQA) measurement set. The range of children having the appropriate measure of BMI was 43 percent for MMC to 51 percent of commercial HMO. Rates for nutrition counseling were slightly higher, with 57 percent for MMC to 65 percent for commercial HMO. Physical activity counseling ranged from 43 percent for MMC to 57 percent for commercial HMO.
  • In 2009, Preferred Provider Organizations and Exclusive Provider Organizations (PPO/EPO) reported QARR for the first time. Twelve entities submitted the required measures. Performance by commercial PPO/EPOs was comparable to the performance of commercial HMO plans across the domains of Child and Adolescent Care, Adults Living with Illnesses, Behavioral Health, and Satisfaction with Care. Commercial PPO performance was slightly lower in the Preventive Care for Women domain.

Women's Health

  • Timely Prenatal Care - In 2000, 87 percent of commercially insured pregnant women and 74 percent of Medicaid-insured pregnant women received prenatal care in the first trimester or within 42 days of their enrollment with the plan. By 2008, those rates increased to 94 percent for commercial and 89 percent for Medicaid.
  • Postpartum visits – In 2000, 73 percent of commercially insured women who had recently given birth received a postpartum visit within the recommended timeframe. For Medicaid, the rate was 60 percent. By 2008, the rate for commercial was 73 percent and for Medicaid, 70 percent.

Child and Adolescent Care

  • The Annual Dental Visit performance measure continued to increase for Medicaid and Child Health Plus. Since 2000, the rate of annual dental visits for Medicaid-insured children and adolescents (ages 4 to 21) rose from 29 percent to 51 percent in 2008. Rates for dental visits (ages 4 to 21) for Child Health Plus rose from 35 percent in 2000 to 61 percent in 2008.
  • Treating sore throats, or the Appropriate Testing for Children with Pharyngitis performance measure, examines the use of antibiotics. The appropriate treatment – no antibiotics – has seen large increases in Medicaid and Child Health Plus since 2003. The gap between Commercial HMO and Medicaid has been reduced from almost 40 percentage points to only 4 percentage points. This illustrates that fewer children are being subjected to antibiotic overuse, which can lead to drug resistance.
  • Year 2003 2008
    Medicaid Managed Care 45% 81%
    Child Health Plus 67% 84%
    Commercial HMO 84% 85%

Adult Preventive, Acute and Chronic Care

  • Medicaid continued to exceed commercial performance for Controlling High Blood Pressure. Between 2006 and 2008, Medicaid rose from 60 percent to 65 percent, while the commercial rate rose from 58 percent to 63 percent. The rise in Medicaid illustrates that an additional 6,500 members with high blood pressure have their pressure controlled as recommended (below 140/90) than two years ago.
  • The Annual Monitoring for Patients on Persistent Medications had higher Medicaid rates than commercial health plans. For example, people on Angiotensin Converting Enzyme (ACE) Inhibitor medications or Angiotensin II Receptor Blocker (ARB) medications and who received the appropriate monitoring tests was 88 percent for Medicaid and 82 percent for commercial. The Medicaid rate rose from 78 percent in 2005 to the current 88 percent while commercial rose from 74 percent to 82 percent in the same time frame.

Health plan results are available by organization and are grouped into six regions of New York: 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 2009 report shows that New Yorkers in these plans continue to receive health care services at rates above the national average.

The annual QARR report is distributed to consumers, libraries, business groups, local health departments and social service agencies, among others.