About eQARR 2020

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, adult health, behavioral health, and experience with care.

The data in eQARR 2020 reflects services and care delivered during 2019 unless otherwise specified (see perinatal health and experience section below).

The Measures

QARR measures are largely adopted from the National Committee for Quality Assurance's (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) with New York State-specific measures added to address public health issues of particular importance in New York.

When available, national averages (benchmarks) from NCQA are also included for the commercial HMO, commercial PPO and Medicaid populations.

QARR data is collected by health plans and the information is validated by a licensed organization. Only valid information is included in the data.

QARR also includes information collected from a national consumer experience survey program called Consumer Assessment of Healthcare Providers and Systems (CAHPS®). CAHPS® is collected every year for commercial adult enrollees. The NYSDOH sponsors a consumer experience survey for Medicaid enrollees every two years.

The perinatal health measures are calculated by the NYSDOH using birth data submitted by the health plans and the Department's Bureau of Vital Statistics. Perinatal health measures are from 2018, as that is the most recent data available.

Types of Insurance

Information on six types of managed care insurance is included in this report: Commercial HMO, Commercial PPO, Medicaid, HIV Special Needs Plan (SNP), Child Health Plus, and Health and Recovery Plan (HARP).

Commercial HMO Commercial HMOs are a type of individual or employer-sponsored health insurance. Typically, the health plan contracts with a designated set of providers, and members select or are assigned to a primary care provider. Members may be required to seek referrals to some services or specialists.
Commercial PPO Commercial PPO/EPOs are a type of individual or employer-sponsored health insurance. PPO/EPO members are not required to select a primary care provider. PPO/EPOs generally allow members to choose any health professional without a referral, both within and outside the designated provider network.
Medicaid Medicaid is a government-sponsored insurance program for persons of all ages whose resources and income are not sufficient to pay for health care. Medicaid functions like a commercial HMO in that members are assigned to a primary care provider and that provider generally coordinates all of their care, including referrals or other special services.
HIV Special Needs Plan (SNP) HIV Special Needs Plan (HIV SNP) is a government-sponsored health insurance plan for persons who are Medicaid-eligible and living with HIV/AIDS, or are homeless, or are transgender in NYC. Dependent children of eligible individuals may also enroll in a SNP. A SNP functions like Medicaid in that it requires care to be directed and coordinated through a primary care physician in a designated network. A SNP is unique because it provides additional special services for people living with HIV/AIDS including substance abuse counseling and supportive social services.
Child Health Plus Child Health Plus is a government-sponsored insurance program for individuals up to age 19, and eligibility is based on a family’s resources and income. Child Health Plus may require the member, or the member’s family, to pay part of the premium. Much like Medicaid, a Child Health Plus member’s care is directed and coordinated by a primary care physician through a designated network of providers. Visits to specialists and other special services generally require a referral under this plan.
Health and Recovery Plan (HARP) Health and Recovery Plan (HARP) is a government-sponsored health insurance program for adults with significant behavioral health needs (e.g., serious mental illness or substance use disorder). HARP members are offered Health Home care management services that develop person-centered plans of care that integrate physical and behavioral health services.

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 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.

The results for HIV Special Needs Plans (SNP) are displayed under Medicaid Managed Care.

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

New York's Health Plans

eQARR contains information about managed care plans serving New York State residents; additional information regarding the counties and populations they serve is presented in the Plan Profile Table and the EPO and PPO 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. Data from plans with low enrollment are not reported but are included in the statewide average calculations.

Also included are NCQA accreditation ratings. NYSDOH does not require NCQA accreditation; the decision to seek NCQA accreditation is voluntary. NCQA 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.

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 seven domains. Information from the CAHPS® consumer experience survey is included in the Provider Network, Adult Health, and in the Experience with Care sections.

Provider Network

Satisfaction with Provider Communication
The percentage of members who responded "usually" or "always" when asked how often their doctor 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. This measure was not collected for 2019 Medicaid; 2018 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Satisfaction with Personal Doctor
The percentage of members responding 8, 9, or 10 (on a scale of 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor) when asked "How would you rate your personal doctor?" This measure was not collected for 2019 Medicaid; 2018 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
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) when asked "How would you rate your specialist?" This measure was not collected for 2019 Medicaid; 2018 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)

Child and Adolescent Health

Adolescent Immunization
The percentage of members, age 13 years, who had one dose of meningococcal conjugate vaccine, one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine by their 13th birthday. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
Adolescent Immunization (Combo 2)
The percentage of adolescent members, age 13 years, who had one dose of meningococcal conjugate vaccine, one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, and have completed the human papillomavirus (HPV) vaccine series by their 13th birthday. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
Childhood Immunization Status (Combo 3)
The percentage of members, age 2 years, who were fully immunized. The HEDIS specifications for fully immunized consists of the following vaccines: four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
Lead Testing
The percentage of children, age 2 years, who had their blood tested for lead poisoning at least once by their 2nd birthday. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
Well-Child & Preventive Care Visits in First 15 Months of Life (5+ Visits)
The percentage of children who had five or more well-child visits with a primary care provider in their first 15 months of life. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
Well-Child & Preventive Care Visits in 3rd, 4th, 5th & 6th Year of Life
The percentage of children, ages 3 to 6 years, who had one or more well-child visits with a primary care provider during the measurement year. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
Adolescent Well-Care Visits
The percentage of adolescents, ages 12 to 21 years, who had at least one comprehensive well-care visit with a primary care provider during the measurement year. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
Annual Dental Visit (Ages 2-18)
The percentage of children and adolescents, ages 2 to 18 years, who had at least one dental visit within the measurement year. (Medicaid/Child Health Plus)
Appropriate Testing for Pharyngitis
The percentage of members, ages 3 to 17 years, who were diagnosed with pharyngitis, were prescribed an antibiotic, and who were given a group A streptococcus test. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
Medication Management for People with Asthma 50% Days Covered (Ages 5-18)
The percentage of children, ages 5 to 18 years, with persistent asthma who filled prescriptions for asthma controller medications during at least 50% of their treatment period. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
Medication Management for People with Asthma 75% Days Covered (Ages 5-18)
The percentage of children, ages 5 to 18 years, with persistent asthma who filled prescriptions for asthma controller medications during at least 75% of their treatment period. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
Asthma Medication Ratio (Ages 5-18)
The percentage of members, ages 5 to 18 years, who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
Weight Assessment and Counseling for Nutrition and Physical Activity
The percentage of children and adolescents, ages 3 to 17 years, who had an outpatient visit with a PCP or OB/GYN practitioner during the measurement year, receiving the following three components of care during the measurement year. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus):
  1. BMI percentile
  2. Counseling for nutrition
  3. Counseling for physical activity
Adolescent Preventive Care
The percentage of adolescents, ages 12 to 17 years, who had at least one outpatient visit with a PCP or OB/GYN practitioner during the measurement year, and received the following four components of care during the measurement year: (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
  1. Assessment, counseling or education on risk behaviors and preventive actions associated with sexual activity
  2. Assessment, counseling or education for depression
  3. Assessment, counseling or education about the risks of tobacco use
  4. Assessment, counseling or education about the risks of substance use (Substance use includes alcohol, street drugs, non-prescription drugs, prescription drug misuse and inhalant use)

Women's Health

Breast Cancer Screening
The percentage of women, ages 50 to 74 years, who had a mammogram anytime on or between October 1 two years prior to the measurement year and December 31 of the measurement year. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Cervical Cancer Screening
The percentage of women, ages 24 to 64 years, who had cervical cytology performed every 3 years or women, ages 30 to 64 years, who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Chlamydia Screening (Ages 16-24)
The percentage of sexually active young women, ages 16 to 24 years, who had at least one test for chlamydia during the measurement year. The measure is reported separately for ages 16 to 20 years and 21 to 24 years. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP,HARP)
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 HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Postpartum Care
The percentage of women who gave birth in the last year who had a postpartum care visit between 21 and 56 days after they gave birth. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Perinatal Health
These measures reflect results of perinatal care for women who had a live birth during 2018. The results are calculated by the Office of Quality and Patient Safety using data from the health plans and from Vital Statistics. 2018 data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
  1. The percentage of women continuously enrolled for 10 or more months who delivered a live birth and had their first prenatal care visit in the first trimester of pregnancy.
  2. The percentage of live infants weighing less than 2500 grams among all deliveries by women continuously enrolled in a plan for 10 or more months. A low rate is desirable for this measure.
  3. The percentage of live infants born by cesarean delivery to women, continuously enrolled for 10 or more months, who had no prior cesarean deliveries. A low rate is desirable for this measure.
  4. The percentage of women continuously enrolled for 10 or more months who delivered a live birth vaginally after having had a prior cesarean delivery.
*For more information about the risk-adjustment methodologies, please refer to the Technical Notes section.

Adult Health

Colorectal Cancer Screening
The percentage of adults, ages 50 to 75 years, who had appropriate screening for colorectal cancer. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Adult BMI Assessment
The percentage of members, ages 18 to 74 years, with an outpatient visit, who had their body mass index (BMI) documented during the measurement year or the year prior to the measurement year. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Flu Vaccination for Adults Ages 18-64
The percentage of members, ages 18 to 64 years, who have had a flu shot. This measure is collected as part of the CAHPS survey. This measure was not collected for 2019 Medicaid; 2018 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Appropriate Testing for Pharyngitis
The percentage of members, ages 18 to 64 years, who were diagnosed with pharyngitis, were prescribed an antibiotic, and who were given a group A streptococcus test. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
Medical Assistance with Smoking and Tobacco Use Cessation
The percentage of members, ages 18 years and older, who are current smokers or tobacco users and who received medical information about smoking or tobacco use cessation within the last 12 months from a health care provider. This measure is collected as part of the CAHPS survey and is calculated as a two year rolling average. This measure was not collected for 2019 Medicaid; 2018 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
  1. Advising Smokers to Quit: The percentage of eligible adults who received cessation advice.
  2. Discussing Cessation Medications: The percentage of eligible adults who discussed or were recommended cessation medications.
  3. Discussing Cessation Strategies: The percentage of eligible adults who discussed or were provided cessation methods or strategies.
Controlling High Blood Pressure
The percentage of members, ages 18 years or older, who had hypertension and whose blood pressure was adequately controlled during the measurement year based on the following criteria: (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
  1. Members, ages 18 to 59 years, whose blood pressure was <140/90 mm Hg.
  2. Members, ages 60 to 85 years, with a diagnosis of diabetes whose blood pressure was <140/90 mm Hg.
  3. Members, ages 60 to 85 years, without a diagnosis of diabetes whose blood pressure was <150/90 mm Hg.
Persistence of Beta-Blocker Treatment
The percentage of members, ages 18 years and older, who were hospitalized after a heart attack and received persistent beta-blocker treatment for six months after discharge. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Asthma Medication Ratio (Ages 19-64)
The percentage of members, ages 19 to 64 years, who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Medication Management for People with Asthma 50% Days Covered (Ages 19-64)
The percentage of members, ages 19 to 64 years, with persistent asthma who filled prescriptions for asthma controller medications during at least 50% of their treatment period. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Medication Management for People with Asthma 75% Days Covered (Ages 19-64)
The percentage of members, ages 19 to 64 years, with persistent asthma who filled prescriptions for asthma controller medications during at least 75% of their treatment period. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
The percentage of members, ages 40 years and older, with a new diagnosis of COPD or newly active COPD, who received spirometry testing to confirm the diagnosis. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Pharmacotherapy Management of COPD Exacerbation
The percentage of COPD exacerbation events for members, ages 40 years and older, who have had an acute inpatient discharge or ED visit and who were dispensed appropriate medications to manage the exacerbation. This measure is presented as two separate rates. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
  1. Corticosteroid Rate: The percentage of events when the member was prescribed a systemic corticosteroid within 14 days of the event.
  2. Bronchodilator Rate: The percentage of events when the member was prescribed a bronchodilator within 30 days of the event.
Comprehensive Diabetes Care
These measures report components of care for members, ages 18 to 75 years, with diabetes and the rates at which they received necessary components of diabetes care. Measures presented here are grouped into those that monitor diabetes and those that measure outcomes for diabetes. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
    Monitoring Diabetes
  1. HbA1c Testing: The percentage of members with diabetes who received at least one Hemoglobin A1c (HbA1c) test within the past year.
  2. Dilated Eye Exam: The percentage of members with diabetes who had a retinal eye screening exam during the last year or who had a negative retinal exam in the year prior.
  3. Medical Attention for Nephropathy: The percentage of members with diabetes who had at least one nephropathy screening test or had evidence of nephropathy during the last year.
  4. Received All Three Tests: The percentage of members with diabetes who received at least one of each of the following tests: HbA1c test, diabetes eye exam, and medical attention for nephropathy.
    Managing Diabetes Outcomes
  1. Poor HbA1c Control: The percentage of members with diabetes whose most recent HbA1c level indicated poor control (>9.0 percent). A low rate is desirable for this measure.
  2. HbA1c Control: The percentage of members with diabetes whose most recent HbA1c level was <8.0 percent.
  3. Blood Pressure Controlled: The percentage of members with diabetes whose most recent blood pressure reading was <140/90 mm Hg.
Statin Therapy for Patients with Cardiovascular Disease
  1. Statin Therapy for Patients with Cardiovascular Disease - Received: The percentage of female members, ages 40 to 75 years, and male members, ages 25 to 75 years, who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and who were dispensed at least one high or moderate-intensity statin medication during the measurement year. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
  2. Statin Therapy for Patients with Cardiovascular Disease - Adherent: The percentage of female members, ages 40 to 75 years, and male members, ages 25 to 75 years, who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and who remained on a high or moderate-intensity statin medication for at least 80% of the treatment period. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Statin Therapy for Patients with Diabetes
  1. Statin Therapy for Patients with Diabetes - Received: The percentage of members, ages 40 to 75 years, with diabetes who do not have clinical atherosclerotic cardiovascular disease (ASCVD) who were dispensed at least one statin medication of any intensity during the measurement year. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
  2. Statin Therapy for Patients with Diabetes - Adherent: The percentage of members, ages 40 to 75 years, with diabetes who do not have clinical atherosclerotic cardiovascular disease (ASCVD) who remained on a statin medication of any intensity for at least 80% of the treatment period. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Viral Load Suppression
The percentage of Medicaid enrollees confirmed HIV-positive who had a HIV viral load less than 200 copies/mL at last HIV viral load test during the measurement year. (Medicaid, HIV SNP, HARP)

Behavioral Health

Follow-up After Emergency Department Visit for Mental Illness
This measure is for members, ages 6 years and older, who were seen in emergency department visits with a principal diagnosis of mental illness, and received recommended outpatient follow-up services within the recommended timeframes. There are two time-frame components for this measure. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
  1. Within 7 Days: The percentage of emergency department (ED) visits for members 6 years of age and older with a principal diagnosis of mental illness, who had a follow-up visit for mental illness within 7 days.
  2. Within 7 Days: The percentage of emergency department (ED) visits for members 6 years of age and older with a principal diagnosis of mental illness, who had a follow-up visit for mental illness within 30 days.
Follow-up After Emergency Department Visit for Alcohol and Other Drug Dependence
This measure is for members, ages 13 years and older, who were seen in emergency department visits with a principal diagnosis of alcohol or other drug dependence (AOD), and received recommended outpatient follow-up services within the recommended timeframes. There are two time-frame components for this measure. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
  1. Within 7 Days: The percentage of members who were seen in emergency department (ED) visits with a principal diagnosis of alcohol or other drug dependence (AOD), who had a follow-up visit for AOD within 7 days.
  2. Within 30 Days: The percentage of members who were seen in emergency department visits (ED) with a principal diagnosis of alcohol or other drug dependence (AOD), who had a follow-up visit for AOD within 30 days.
Antidepressant Medication Management
This measure is for members, ages 18 years and older, who were diagnosed with depression and treated with an antidepressant medication. There are two components for this measure. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
  1. Effective Acute Phase Treatment: The percentage of members who remained on antidepressant medication during the entire 12-week acute treatment phase.
  2. Effective Continuation Phase Treatment: The percentage of members who remained on antidepressant medication for at least six months.
Follow-up After Hospitalization for Mental Illness
This measure is for members, ages 6 years and older, who were hospitalized for treatment of selected mental health disorders and has two time-frame components. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
  1. Within 7 Days: The percentage of members who were seen on an ambulatory 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 seen on an ambulatory basis or who were in intermediate treatment with a mental health provider within 30 days of discharge.
Adherence to Antipsychotic Medications for Individuals with Schizophrenia
The percentage of members, ages 19 to 64 years, during the measurement year with schizophrenia who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period. (Medicaid, HIV SNP, HARP)
Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia
The percentage of members, ages 18 to 64 years, with cardiovascular disease and schizophrenia who had an LDL-C test during the measurement year. (Medicaid, HIV SNP, HARP)
Diabetes Screening for People with Schizophrenia or Bipolar Disorder Using Antipsychotic Medications
The percentage of members, ages 18 to 64 years, with schizophrenia or bipolar disorder who were dispensed an antipsychotic medication and had a diabetes screening test during the measurement year.(Medicaid, HIV SNP, HARP)
Diabetes Monitoring for People with Diabetes and Schizophrenia
The percentage of members, ages 18 to 64 years, with diabetes and schizophrenia who had both an LDL-C test and an HbA1c test during the measurement year. (Medicaid, HIV SNP, HARP)

Behavioral Health for Children and Adolescents

Metabolic Monitoring for Children and Adolescents on Antipsychotics
The percentage of children and adolescents, ages 1 to 17 years, who had two or more antipsychotic prescriptions and had metabolic testing. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics
The percentage of children and adolescents, ages 1 to 17 years, who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
Follow-Up Care for Children Prescribed ADHD Medication
The percentage of children, ages 6 to 12 years, who were newly prescribed ADHD medication and who had at least three follow-up visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed. There are two measures to assess follow-up care for children taking ADHD medication. (Commercial HMO, Commercial PPO, Medicaid/Child Health Plus)
  1. Initiation Phase: The percentage of children with a new prescription for ADHD medication and who had one follow-up visit with a practitioner within the 30 days after starting the medication.
  2. Continuation & Maintenance Phase: The percentage of children with a new prescription for ADHD medication who remained on the medication for 7 months and who, in addition to the visit in the Initiation Phase, had at least two follow-up visits in the 9-month period after the initiation phase ended.

Experience with Care for Adults

Getting Care Needed
The percentage of members responding "usually" or "always" when asked a set of questions to identify if they received care they needed. This measure was not collected for 2019 Medicaid; 2018 Medicaid data is presented in this report. The following questions are contained in this composite: (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
  1. How often was it easy to get the care, tests, or treatment you needed?
  2. How often did you get an appointment to see a specialist as soon as you needed?
Getting Care Quickly
The percentage of members responding "usually" or "always" when asked a set of questions to identify if they received health services quickly. This measure was not collected for 2019 Medicaid; 2018 Medicaid data is presented in this report. The following questions are contained in this composite:(Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
  1. When you needed care right away, how often did you get care as soon as you needed?
  2. How often did you get an appointment for a check-up or routine care at a doctor's office or clinic as soon as you needed?
Claims Processing
The percentage of members responding "usually" or "always" when asked a set of questions to identify how, in the last 12 months, their health plan handled claims. The following questions are contained in this composite: (Commercial HMO, Commercial PPO)
  1. How often did your health plan handle your claims quickly?
  2. How often did your health plan handle your claims correctly?
Plan Information on Cost
The percentage of members responding "usually" or "always" when asked a set of questions to identify if, in the last 12 months, they looked for information about health care costs. The following questions are contained in this composite: (Commercial HMO, Commercial PPO)
  1. How often were you able to find out from your health plan how much you would have to pay for a health care service or treatment?
  2. How often were you able to find out from your health plan how much you would have to pay for specific prescription medicines?
Customer Service
The percentage of members responding "usually" or "always" when asked a set of questions to identify if they used their health plan's customer service. This measure was not collected for 2019 Medicaid; 2018 Medicaid data is presented in this report. The following questions are contained in this composite: (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
  1. How often did your health plan's customer service give you the information or help you needed?
  2. How often did your health plan's customer service staff treat you with courtesy and respect?
Rating of Health Plan
The percentage of members responding 8, 9 or 10 on a scale of 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible. This measure was not collected for 2019 Medicaid; 2018 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Shared Decision Making
.
  1. Did you and a doctor or other health provider talk about the reasons you might want to take a medicine?
  2. Did you and a doctor or other health provider talk about the reasons you might not want to take a medicine?
  3. When you talked about starting or stopping a prescription medication, did a doctor or other health provider ask you what you thought was best for you?
Care Coordination
The percentage who responded "usually" or "always" when asked how often their personal doctor seemed informed and up-to-date about care they received from other doctors or health providers. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Wellness Discussion
The percentage who responded "yes" when asked if they discussed with a doctor or other health care provider specific things they could do to prevent illness. This measure was not collected for 2019 Medicaid; 2018 Medicaid data is presented in this report. (Medicaid, HIV SNP, HARP)
Rating of Overall Healthcare
The percentage of members responding 8, 9 or 10 on scale of 0 to 10, where 0 is the worst healthcare possible and 10 is the best healthcare possible. This measure was not collected for 2019 Medicaid; 2018 Medicaid data is presented in this report. (Commercial HMO, Commercial PPO, Medicaid, HIV SNP, HARP)
Getting Needed Counseling or Treatment
The percentage who responded "usually" or "always" when asked how often, in the past 6 months, it was easy to get counseling or treatment for a personal or family problem through their health plan. This measure was not collected for 2019 Medicaid; 2018 Medicaid data is presented in this report. (Medicaid, HIV SNP, HARP)
Rating of Counseling or Treatment
The percentage of members responding 8, 9, or 10 on a scale of 0 to 10, where 0 is the worst counseling or treatment possible and 10 is the best counseling or treatment possible. This measure was not collected for 2019 Medicaid; 2018 Medicaid data is presented in this report. (Medicaid, HIV SNP, HARP)

Experience with Care for Children

Getting Care Needed for Children
The percentage of parents responding "usually" or "always" when asked a set of questions to identify if, in the last 6 months, their child received care they needed. The following questions are contained in this composite: (Medicaid/Child Health Plus)
  1. How often was it easy to get appointments with specialists?
  2. How often was it easy to get the care, tests, or treatment you thought your child needed through your health plan?
Getting Care Quickly for Children
The percentage of parents responding "usually" or "always" when asked a set of questions to identify if, in the last 6 months, their child received health services quickly. The following questions are contained in this composite: (Medicaid/Child Health Plus)
  1. When your child needed care right away for an illness, injury, or condition, how often did your child get care as soon as you wanted?
  2. Not counting the times your child needed health care right away, how often did your child get an appointment for health care as soon as you wanted?
Access to Prescription Medicines for Children
The percentage of parents responding "usually" or "always" when asked how often in the past 6 months, it was easy to get prescription medicines for their child through the child's health plan. (Medicaid/Child Health Plus)

Access to Specialized Services for Children
The percentage of parents responding "usually" or "always" when asked a set of questions to identify, if, in the past 6 months, the child received the specialized services the child needed. The following questions are contained in this composite: (Medicaid/Child Health Plus)
  1. How often was it easy to get special medical equipment or devices for your child?
  2. How often was it easy to get physical, occupational, or speech therapy for your child?
  3. How often was it easy to get emotional, developmental, or behavioral treatment or counseling for your child?
Rating of Health Plan for Children
The percentage of parents 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) what number would you use to rate your child's health plan. (Medicaid/Child Health Plus)
Customer Service for Children
The percentage of parents responding "usually" or "always" when asked a set of questions to identify if, in the last 6 months, they used their child's health plan's customer service. The following questions are contained in this composite: (Medicaid/Child Health Plus)
  1. How often did your child's health plan's customer service give you the information or help you needed?
  2. How often did your child's health plan's customer service staff treat you with courtesy and respect?
Shared Decision Making for Children
The percentage of parents responding "yes" and "a lot" when asked a set of questions to identify if, in the last 6 months, they made healthcare decisions with their child's doctor. The following questions are contained in this composite: (Medicaid/Child Health Plus)
  1. When you talked about your child starting or stopping a prescription medicine, how much did a doctor or other health provider talk about the reasons you might want your child to take a medicine?
  2. When you talked about your child starting or stopping a prescription medicine, how much did a doctor or other health provider talk about the reasons you might not want your child to take a medicine?
  3. When you talked about your child starting or stopping a prescription medicine, did a doctor or other health provider ask you what you thought was best for your child?
Coordination of Care for Children with Chronic Conditions
The percentage of parents responding "yes" when asked a set of questions to identify if, in the last 6 months, they received needed healthcare coordination with daycare, school, or other healthcare providers. The following questions are contained in this composite: (Medicaid/Child Health Plus)
  1. Did you get the help you needed from your child's doctor or other health providers in contacting your child's school or daycare?
  2. Did anyone from your child's health plan, doctor's office or clinic help you coordinate your child's care among different providers or health care services?
Rating of Overall Healthcare for Children
The percentage of parents responding 8, 9 or 10 (on scale of 0 to 10, where 0 is the worst healthcare possible and 10 is the best healthcare possible) when asked what number would you use to rate all your child's health care in the last 6 months.. (Medicaid/Child Health Plus)
Satisfaction with Personal Doctor for Children
The percentage of parents responding 8, 9, or 10 (on a scale of 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor) when asked "How would you rate your child's personal doctor?" (Medicaid/Child Health Plus)
Satisfaction with Specialist for Children
The percentage of parents 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 the specialist your child sees most often?" (Medicaid/Child Health Plus)
Satisfaction with Provider Communication for Children
The percentage of parents who responded "usually" or "always" when asked how often their doctor 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. (Medicaid/Child Health Plus)
Family-Centered Care: Personal Doctor Who Knows Child
The percentage of parents responding "yes" when asked a set of questions to identify if, in the last 6 months, their child's doctor knew about the child's and family's daily living needs. The following questions are contained in this composite: (Medicaid/Child Health Plus)
  1. Did your child's personal doctor talk with you about how your child is feeling, growing, or behaving?
  2. Does your child's personal doctor understand how the child's medical, behavioral, or other health conditions affect your child's day-to-day life?
  3. Does your child's personal doctor understand how the child's medical, behavioral, or other health conditions affect your family's day-to-day life?

Need More Information

If you have any questions or comments about eQARR or would like copies of the Consumer Guides, please contact the Office of Quality & Patient Safety at (518)486-9012 or e-mail nysqarr@health.ny.gov.