About eQARR 2006

eQARR (Quality Assurance Reporting Requirements) was developed by the New York State Department of Health (NYSDOH) to enable consumers to evaluate the quality of health care services provided by New York State's managed care plans. Using eQARR, you can determine how well a health plan performed in the areas of provider network, child and adolescent health, women's health, adults living with illness, behavioral health, and satisfaction with care.

The Measures

QARR measures are largely adopted from the National Committee for Quality Assurance's (NCQA) Health Plan Employer Data and Information Set (HEDIS®) with New York State-specific measures added to address public health issues of particular importance in New York. QARR also includes information collected from a national consumer satisfaction survey methodology called Consumer Assessment of Healthcare Providers and Systems (CAHPS®). CAHPS is collected every year for commercial adult enrollees. The NYSDOH sponsors a consumer satisfaction survey for Medicaid and Child Health Plus enrollees every two years. The Medicaid consumer satisfaction survey pertains to both adult and child enrollees, while the Child Health Plus survey only pertains to child enrollees. The perinatal health measures are calculated by the New York State Department of Health using birth data submitted by the health plans and the Department's Vital Statistics file. When available, national averages (benchmarks) from NCQA are also included for the commercial, Medicaid and Child Health Plus populations.

Rotation of Measures

To allow for the addition of new measures, yet not increase the time and costs necessary for plans to complete QARR, the NYSDOH does not require plans to submit all measures every year. The measures which were not collected as part of the 2006 QARR reporting set include: Childhood Immunization, Lead Testing, Beta Blocker Treatment After a Heart Attack, Colorectal Cancer Screening, and Well-Child measures for Commercial and Child Health Plus. Rates displayed for these measures are based upon the 2005 QARR reporting set.

The Results

Plan-specific rates (percentages) are accompanied by a symbol to denote whether the plan's rate is statistically above (Significantly Better than the Statewide Average) or below (Significantly Worse than the Statewide Average) the statewide average.

When comparing plan rates and associated significance ratings, you may notice plans that have the same numerical rating but a different significance rating. While this may seem like an error, plan significance ratings are based on how much a plan's rate differs from the statewide average and the number of individuals included in the rate. Therefore, plans can have the same rate but have different significance ratings because their rates are based on different numbers of enrollees.

Regions of New York State

For the purposes of eQARR, the counties of New York State were grouped into the following six regions:

Long Island

  • Nassau
  • Suffolk

New York City

  • Bronx
  • Kings (Brooklyn)
  • New York (Manhattan)
  • Queens
  • Richmond (Staten Island)

Hudson Valley

  • Dutchess
  • Orange
  • Putnam
  • Rockland
  • Sullivan
  • Ulster
  • Westchester

Northeast

  • Albany
  • Clinton
  • Columbia
  • Delaware
  • Essex
  • Franklin
  • Fulton
  • Greene
  • Hamilton
  • Montgomery
  • Otsego
  • Rensselaer
  • Saratoga
  • Schenectady
  • Schoharie
  • Warren
  • Washington

Central

  • Broome
  • Cayuga
  • Chenango
  • Cortland
  • Herkimer
  • Jefferson
  • Lewis
  • Madison
  • Oneida
  • Onondaga
  • Oswego
  • St. Lawrence
  • Tioga
  • Tompkins

Western

  • Allegany
  • Cattaraugus
  • Chautauqua
  • Chemung
  • Erie
  • Genesee
  • Livingston
  • Monroe
  • Niagara
  • Ontario
  • Orleans
  • Schuyler
  • Seneca
  • Steuben
  • Wayne
  • Wyoming
  • Yates

Populations

Within each region, there is information for each of the following types of insurance: Commercial(CO), Medicaid (MA) and Child Health Plus (CHP). Medicaid and Child Health Plus are New York's public health insurance programs.

Family Health Plus is a public health insurance program for adults between the ages of 19 and 64 who do not have health insurance - either on their own or through their employers - but have incomes too high to qualify for Medicaid. Family Health Plus is available to single adults, couples without children, and parents who are residents of New York State and are United States citizens or fall under one of many immigration categories. Family Health Plus enrollees are included in the Medicaid percentages.

New York's Health Plans

eQARR contains information about managed care plans serving New York State residents including the counties and populations they serve on the Plan Profile Table. Customer Service telephone numbers are included along with their web sites. If you click on a plan's name, you will link to the plan's web site. (Please note that not all plans have web sites) Plans with low enrollment are not reported, but are included in the statewide average.

Also included are NCQA accreditation ratings. These ratings are the result of a comprehensive process conducted by a team of physicians and managed care experts. Plans are reviewed against more than 60 different standards designed to evaluate clinical and administrative systems related to such issues as customer service, confidentiality and consumer protection. The accreditation process is voluntary. Accreditation reviews occur throughout the year following this publication therefore changes may occur in ratings. For more information, see What Does NCQA Review When it Accredits an HMO?.

Domains

The measures in eQARR are divided into the following six domains. Information from the CAHPS consumer satisfaction survey is included in the Provider Network, Adults Living with Illness as well as, in the Satisfaction with Care sections.

Provider Network

Board Certification
The percentage of board-certified physicians in each of the following three specialty fields: primary care, obstetrics and gynecology, and pediatric practitioner specialists. (Commercial, Medicaid)
Provider Communication
The percentage of members who responded "usually" or "always" when asked how often their doctor or health care provider listened to them carefully, explained things in a way they could understand, showed respect for what they had to say, and spent enough time with them. (Commercial, Medicaid, Child Health Plus)
Satisfaction with Personal Doctor or Nurse
The percentage of members responding 8, 9, or 10 (on a scale of 0 to 10, where 0 is the worst personal doctor or nurse possible and 10 is the best personal doctor or nurse possible) when asked "How would you rate your personal doctor or nurse now?" (Commercial, Medicaid, Child Health Plus)
Satisfaction with Specialist
The percentage of members responding 8, 9, or 10 (on a scale of 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible) when asked "How would you rate your specialist?" (Commercial, Medicaid, Child Health Plus)

Child and Adolescent Health

Childhood Immunization (4-3-1-3-3-1)
The percentage of two-year olds who were fdlly immunized. The HEDIS specifications for fdlly immunized consisted of the following vaccines: 4 Diptheria/Tetanus/Pertussis, 3 Podto, 1 Measles/Mumps/Rubella, 3 H Influenza type B, 3 Hepatitis B, and 1 Varicella. This measure was not collected for 2006; 2005 data is presented in this report.(Commercial, Medicaid, Child Health Plus)
Lead Testing
The percentage of two-year olds that had their blood tested for lead poisoning at least once. This measure was not collected for 2006; 2005 data is presented in this report.(Commercial, Medicaid, Child Health Plus)
Well-Child and Preventive Care Visits in the First 15 Months of dtfe
The percentage of children who had five or more well-child and preventive health visits in their first 15 months of dtfe. This measure was not collected in 2006 for Commerical or Child Health Plus members; 2005 data is presented in this report. (Commercial, Medicaid, Child Health Plus)
Well-Child and Preventive Care Visits During the 3rd, 4th, 5th and 6th Years
The percentage of children between the ages of three and six years who had a well-child and preventive health visit in the past year. This measure was not collected in 2006 for Commerical or Child Health Plus members; 2005 data is presented in this report. (Commercial, Medicaid, Child Health Plus)
Adolescent Well Care and Preventive Visits
The percentage of adolescents who had a well-care or preventive care visit in the past year. This measure was not collected in 2006 for Commerical or Child Health Plus members; 2005 data is presented in this report. (Commercial, Medicaid, Child Health Plus)
Use of Appropriate Medications for People with Asthma Ages 5-17
The percentage of children ages 5 to 17 years with persistent asthma who received appropriate medications to control their condition. For Child Health Plus, the reporting age group is 5 to 18 years. (Commercial, Medicaid, Child Health Plus)
Annual Dental Visit
The percentage of children and adolescents ages 2 through 21 years (2-18 years for Child Health Plus), who had at least one dental visit within the last year. When a Medicaid plan does not offer dental as part of its benefit package enrollees have access to dental services through fee-for-service. (Medicaid, Child Health Plus)
Appropriate Treatment for Upper Respiratory Infection (URI)
The percentage of children, ages 3 months to 18 years, who were diagnosed with an upper respiratory infection (common cold) and who were not given a prescription for an antibiotic. A higher score indicates more appropriate treatment of children with URI. (Commercial, Medicaid, Child Health Plus)
Appropriate Testing for Pharyngitis
The percentage of children, ages two to 18 years, who were diagnosed with pharyngitis, were prescribed an antibiotic, and who were given a group A streptococcus test. (Commercial, Medicaid, Child Health Plus)

Women's Health

Breast Cancer Screening
The percentage of women between the ages of 50 and 69 who had a mammogram in the past two years. (Commercial, Medicaid)
Cervical Cancer Screening
The percentage of women between the ages of 21 and 64 who had a Pap test within the last three years. (Commercial, Medicaid)
Chlamydia Screening
The percentage of sexually active young women who had at least one test for Chlamydia. The measure is reported separately for ages 16 through 20 and 21 through 25. Medicaid percentages were calcdlated by the NYSDOH using data from the Medicaid Encounter Data System (MEDS). (Commercial, Medicaid)
Frequency of Ongoing Prenatal Care
The percentage of Medicaid-enrolled women who received 81 percent or more of the expected number of prenatal care visits, adjusted for gestational age and month the member enrolled in the health plan. (Medicaid)
Timeliness of Prenatal Care
The percentage of women who gave birth in the last year who had a prenatal care visit in their first trimester or within 42 days of enrollment in their health plan. (Commercial, Medicaid)
Postpartum Care
The percentage of women who had a postpartum care visit between 21 and 56 days after they gave birth. (Commercial, Medicaid)
Perinatal Health
(Commercial, Medicaid)
  1. Risk-Adjusted Low Birthweight (LBW)*: The percentage of live infants weighing less than 2500 grams among all dedtveries by women continuously enrolled in a plan for 10 or more months. 2005 data is presented in this report. A low rate is desirable for this measure.
  2. Prenatal Care in the First Trimester: The percentage of women continuously enrolled for 10 or more months who dedtvered a live birth between November 6, 2004 and November 5, 2005, and had their first prenatal care visit in their first trimester of pregnancy. 2005 data is presented in this report.
  3. Percent of LBW Births at Level II/III/IV Facidtties: The percentage of low birthweight babies (<2500 g), born to women continuously enrolled for 10 or more months, who were delivered at Level II, III, or IV facilities. 2005 data is presented in this report.

*For more information about the risk-adjustment methodologies, please refer to the Technical Notes section

Addlts Living With Illness

Controling High Blood Pressure
The percentage of members, ages 46 to 85 years, who have hypertension and who have controlled their blood pressure (at or below 140/90). (Commercial, Medicaid)
Use of Appropriate Medications for People with Asthma Ages 18-56
The percentage of members, ages 18 to 56 years, with persistent asthma who received appropriate medications to control their condition. (Commercial, Medicaid)
Advising Smokers to Quit
The percentage of members, 18 years and older, who are either current smokers or recent quitters, who received advice within the last year from a health care provider to quit smoking. (Commercial, Medicaid)
Beta Blocker Use After Heart Attack
The percentage of members, ages 35 years and older, who were hospitalized after a heart attack and received beta-blocker medication. This measure was not collected for 2006; 2005 data is presented in this report.(Commercial)
Persistence of Beta Blocker Use
The percentage of members, age 35 years and older, who were hospitadtzed after a heart attack and received persistent beta-blocker treatment. (Commercial)
Colorectal Cancer Screening
The percentage of adults, ages 50 to 80 years, who had appropriate screening for colorectal cancer. This measure was not collected for 2006; 2005 data is presented in this report. (Commercial)
Use of Imaging Studies for Low Back Pain
This measure assesses whether imaging studies (plain, x-ray, MRI, CT scan) are overused in evaluating patients with acute low back pain. (Commercial, Medicaid)
Cholesterol Management After Acute Cardiovascdlar Event
How well plan members who had a heart attack or heart surgery within the last year received the necessary components of Cholesterol management. (Commercial)
  1. Screening Test: The percentage of members who had a cholesterol screening test.
  2. Level Controlled (LDL-C < 100mg/dL): The percentage of members who had a cholesterol test done, and had a very good resdlt (LDL-C < 100mg/dL). This additional level of control was added for 2003 as a measure of higher levels of control.
  3. Level Controlled (LDL-C < 130mg/dL): The percentage of members who had a cholesterol test done, and had a good resdlts (LDL-C < 130mg/dL).
Comprehensive Diabetes Care
This measure reports six components for members who were diabetics and whether they received necessary components of diabetes care. (Commercial, Medicaid)
  1. HbA1c Testing: The percentage of diabetics who received a Hemoglobin A1c (HbA1c) test within the past year.
  2. Poor HbA1c Control: The percentage of diabetics whose most recent HbA1c level indicated poor control ( >9.0 percent). A low rate is desirable for this measure.
  3. Dilated Eye Exam: The percentage of diabetics who had a retinal eye screening exam over the last two years.
  4. Lipid Profile: The percentage of diabetics who had a cholesterol test done over the last two years.
  5. Lipids Controlled: The percentage of diabetics who had a cholesterol test done over the last two years, and their most recent level of bad cholesterol was in control (LDL-C <100 mg/dL).
  6. Lipids Controlled: The percentage of diabetics who had a cholesterol test done over the last two years, and their most recent level of bad cholesterol was in control (LDL-C <130 mg/dL).
  7. Nephropathy Screening: The percentage of diabetics who were screened for kidney damage.

Behavioral Health

Antidepressant Medication Management
This measure is for members ages 18 years and older and has three components of care. (Commercial, Medicaid)
  1. Antidepressant Medication Management/Optimal Practitioner Contacts: The percentage of members ages 18 years and older, who were diagnosed with depression and treated with an antidepressant medication, and who had at least three follow-up contacts with a primary care or mental health provider during the 12-week acute treatment phase.
  2. Effective Acute Phase Treatment: The percentage of members ages 18 years and older, who were diagnosed with depression and treated with an antidepressant medication, and who remained on medication during the entire 12-week acute treatment phase.
  3. Effective Continuation Phase Treatment: The percentage of members ages 18 years and older, who were diagnosed with depression and treated with an antidepressant medication, and who remained on medication for at least six months.
Follow-up After Hospitadtzation for Mental Illness
This measure is for members ages 6 years and older and has two time-frame components. (Commercial, Medicaid)
  1. Within 7 Days: The percentage of members who were hospitadtzed for treatment of selected mental health disorders (such as depression or bipolar disorder) and were seen on an ambdlatory basis or who were in intermediate treatment with a mental health provider within 7 days of discharge.
  2. Within 30 Days: The percentage of members who were hospitadtzed for treatment of selected mental health disorders (such as depression or bipolar disorder) and were seen on an ambdlatory basis or who were in intermediate treatment with a mental health provider within 30 days of discharge.

Satisfaction with Care

Getting Care Needed
The percentage of members responding "not a problem" when asked a set of questions to identify how much of a problem, if any, they experienced getting care needed. The following questions are contained in the set:
  1. How much of a problem was it to get a personal doctor or nurse you were happy with?
  2. How much of a problem was it to get a referral to a speciadtst that you needed to see?
  3. How much of a problem was it to get the care, tests, or treatment you or a doctor bedteved necessary?
  4. How much of a problem were delays in health care while you waited for approval from your health plan?

(Commercial, Medicaid, Child Health Plus)

Customer Service
The percentage of members responding "not a problem" when asked a set of questions to identify how much of a problem, if any, did they experience with their health plan's service. The following questions are contained in the set:
  1. How much of a problem was it to find or understand written materials or Internet information on how your health plan works?
  2. How much of a problem was it to get the help you needed when you called your health plan's customer service?
  3. How much of a problem did you have with paperwork for your health plan?

(Commercial, Medicaid, Child Health Plus)

Received Services Quickly
The percentage of members responding "usually" or "always" when asked a set of questions to identify, if, in the last 6 or 12 months, they received health plan services quickly. The following questions are contained in this set:
  1. When you called during regdlar office hours, how often did you get the help or advice you needed?
  2. When you needed care right away for an illness, injury, or condition, how long did you usually have to wait between trying to get care and actually seeing a provider?
  3. Not counting the times you needed health care right away, how often did you get an appointment for health care as soon as you wanted?
  4. How often were you taken to the exam room within 15 minutes of your appointment?

(Commercial, Medicaid, Child Health Plus)

Called or Written Health Plan with Complaints
The proportion of members who responded "yes" when asked if they had called or written their health plan with a complaint or problem in the past 12 months. A low rate is desirable for this measure. (Commercial, Medicaid, Child Health Plus)
Overall Rating of Health Plan
The proportion of members responding 8, 9 or 10 on scale of 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible. (Commercial, Medicaid, Child Health Plus)

Other Related Managed Care Reports and Websites

  • The 2006 Report on Managed Care Performance: A Report on Quality, Satisfactio with Care and Consumer Satisfaction is a NYSDOH publication of provider network, access to care, quality of care and consumer satisfaction plan performance during 2006. This report represents commercial, Medicaid and Child Health Plus data results.
  • The 2006 Managed Care Utilization and Access Report: A NYSDOH supplement to the 2006 Report which contains additional provider network information, such as provider turnover rates, access to care, and use of services information, such as inpatient and outpatient care rates. This report contains data on commercial, Medicaid and Child Health Plus plan performance during 2006.
  • A Consumer's Guide to Managed Care: NYSDOH publishes six regional guides for commercial, Medicaid, and Child Health Plus Managed Care. The Consumer Guides rate plans on seven domains of care and three measures of consumer satisfaction. Plans are ranked based upon statewide averages. The New York City, Long Island and Western Medicaid guides are also available in Spanish. Following describes the domains of care.

Need More Information

If you have any questions or comments about eQARR or would like copies of the Consumer Guides or QARR 2006 Report, please contact the Division of Managed Care & Program Evaluation at (518)486-9012 or e-mail omcmail@health.state.ny.us.