About eQARR 2022

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 2022 reflects services and care delivered during 2022 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 Managed Care 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 CAHPS® survey for Medicaid Managed Care Plans adult and child members alternating every other year.

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 2021, as that is the most recent data available.

Types of Insurance

Information on seven types of managed care insurance is included in this report: Commercial HMO, Commercial PPO, Medicaid Managed Care (MMC), HIV Special Needs Plan (SNP), Child Health Plus, Health and Recovery Plan (HARP), and Essential Plan (EP). Hereafter, we will use the term Medicaid Managed Care Plans (MMCP) to refer MMC, HIV SNP and HARP plans together for simplicity.

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 Managed Care (MMC)	Medicaid Managed Care is a government-sponsored insurance program for persons of all ages whose resources and income are not sufficient to pay for health care. MMC 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 Managed Care 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.
Health and Recovery Plan (HARP)	Health and Recovery Plan (HARP) is a government-sponsored health insurance program for adults who are Medicaid-eligible and living 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.
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 Managed Care, 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.
Essential Plan (EP)	Essential Plan (EP) is a government-sponsored health insurance program for adults aged 19-64 years, who are not eligible for Medicaid, Child Health Plus, employer or other coverage, and meet EP plan income requirements. EP members are charged very low or no premium, and are offered the same essential benefits as other plans.

Rotation of Measures

Some services require more resource intensive methods of collection, and these measures are often rotated to control collection burden. When a measure is rotated for the reporting year, the data from the prior collection cycle is included. The measures which were not collected as part of the 2022 QARR measurement set include: CAHPS® Survey results for Adults in Medicaid Managed Care Plans. Rates displayed for these measures are based upon services delivered during 2021.

The Results

Plan-specific rates (percentages) are accompanied by a symbol to denote whether the plan's rate is statistically above () or below () 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 Child Health Plus are displayed under Medicaid Managed Care.

Measure Trending

Sometimes a measure's specifications change. These changes affect the results or alter the target population in such a manner that previous results for the measure are not comparable to current results. In such cases, NYSDOH states that the changed measure is not "trendable".

Measures that cannot be trended with the 2022 QARR/HEDIS® measurement set are as follows:

• Colorectal Cancer Screening
• Diagnosed Mental Health Disorders
• Diagnosed Substance Use Disorders
• Follow-Up After Emergency Department Visit for Substance Use
• Use of Imaging Studies for Low Back Pain
• Initiation and Engagement of Substance Use Disorder Treatment

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, EPO and PPO Plan Profile Table and the EP 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 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. (Commercial HMO, Commercial PPO, MMCP, EP)

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 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. (Commercial HMO, Commercial PPO, MMCP, EP)

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 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. (Commercial HMO, Commercial PPO, MMCP, EP)

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, MMC/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, MMC/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, MMC/Child Health Plus)

Lead Screening for Children

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, MMC/Child Health Plus)

Well-Child Visits in the First 30 Months of Life (First 30 Months)

The percentage of members who turned 15 or 30 months old during the measurement year, who had the recommended number of well-child visits during the last 15 months. (Commercial HMO, Commercial PPO, MMC/Child Health Plus)

Child and Adolescent Well-Care Visits (Total)

The percentage of members, ages 3 to 21 years, who had at least one well-care visit during the measurement year. (Commercial HMO, Commercial PPO, MMC/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. (MMC/Child Health Plus)

Appropriate Testing for Pharyngitis

The percentage of episodes for members, ages 3 to 17 years, where the member was diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode. (Commercial HMO, Commercial PPO, MMC/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, MMC/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, MMC/Child Health Plus):

1. BMI percentile
2. Counseling for nutrition
3. Counseling for physical activity

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, MMCP, EP)

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, MMCP, EP)

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, MMCP, EP)

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, MMCP)

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, MMCP)

Prenatal Immunization Status Combination

The percentage of deliveries in the Measurement Period in which women had received influenza and tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccinations. (Commercial HMO, Commercial PPO, MMCP)

Perinatal Health

These measures reflect results of perinatal care for women who had a live birth during 2021. The results are calculated by the Office of Quality and Patient Safety using data from the health plans and from Vital Statistics. 2021 data is presented in this report. (Commercial HMO, Commercial PPO, MMCP)

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, MMCP, EP)

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 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. (Commercial HMO, Commercial PPO, MMCP, EP)

Annual Dental Visit (Ages 19-20)

The percentage of young adults, ages 19 to 20 years, who had at least one dental visit within the last year. (MMC)

Appropriate Testing for Pharyngitis

The percentage of episodes for members, ages 18 to 64 years, where the member was diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode. (Commercial HMO, Commercial PPO, MMC, HIV SNP, HARP, EP)

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 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. (Commercial HMO, Commercial PPO, MMCP, EP)

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

Controlling High Blood Pressure: The percentage of members, ages 18-85 years, who had hypertension and whose blood pressure was adequately controlled (<140/9 0mm Hg) during the measurement year.(Commercial HMO, Commercial PPO, MMCP, EP)

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, MMCP, EP)

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, MMCP)

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, MMCP, EP)

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.

Eye Exam for Patients With Diabetes

Eye Exam for Patients With Diabetes : The percentage of members with diabetes who had a retinal eye screening exam during the measurement year or who had a negative retinal exam in the year prior to the measurement year.(Commercial HMO, Commercial PPO, MMCP, EP)

Hemoglobin A1c Control for Patients With Diabetes

The percentage of members 18-75 years of age with diabetes (types 1 and 2) whose hemoglobin A1c (HbA1c) was at the following levels during the measurement year.(Commercial HMO, Commercial PPO, MMCP, EP)

1. HbA1c poor 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.

Blood Pressure Control for Patients With Diabetes

Blood Pressure Control for Patients With Diabetes: The percentage of members, ages 18-75 years, with diabetes whose most recent blood pressure reading was <140/90 mm Hg.(Commercial HMO, Commercial PPO, MMCP, EP)

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 21 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, MMCP, EP)
2. Statin Therapy for Patients with Cardiovascular Disease - Adherent: The percentage of female members, ages 40 to 75 years, and male members, ages 21 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, MMCP, EP)

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, MMCP, EP)
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, MMCP, EP)

Viral Load Suppression

The percentage of Medicaid Managed Care Plan 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. (MMCP)

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, MMCP, EP)

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 30 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 Substance Use

This measure is for members, ages 13 years and older, who were seen in emergency department visits with a principal diagnosis of substance use disorder (SUD),or any diagnosis of drug overdose, for which they received recommended outpatient follow-up services within the recommended timeframes.(Commercial HMO, Commercial PPO, MMCP, EP)

1. Within 7 Days: The percentage of members who were seen in emergency department (ED) visits with a principal diagnosis of substance use disorder (SUD),or any diagnosis of drug overdose, and 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 substance use disorder (SUD),or any diagnosis of drug overdose, and had a follow-up visit for AOD within 30 days.

Follow-Up After High-Intensity Care for Substance Use Disorder

This measure is for members, ages 13 years and older, with an acute inpatient hospitalization, residential treatment or detoxification visit for Substance Use Disorder. There are two time-frame components for this measure. (Commercial HMO, Commercial PPO, MMCP, EP)

1. Within 7 Days: The percentage of visits or discharges for which members 13 years of age and older received follow-up for substance use disorder within the 7 days after the visit or discharge
2. Within 30 Days: The percentage of visits or discharges for which members 13 years of age and older received follow-up for substance use disorder within the 30 days after the visit or discharge

Pharmacotherapy for Opioid Use Disorder

The percentage of new opioid use disorder (OUD) pharmacotherapy events with OUD pharmacotherapy for 180 or more days among members 16 years and older with a diagnosis of OUD. (Commercial HMO, Commercial PPO, MMCP, EP)

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, MMCP, EP)

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, MMCP, EP)

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. (Commercial HMO, Commercial PPO, MMCP, EP)

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. (MMCP)

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.(MMCP)

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. (MMCP)

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, MMC/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, MMC/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, MMC/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 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. The following questions are contained in this composite: (Commercial HMO, Commercial PPO, MMCP, EP)

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 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. The following questions are contained in this composite:(Commercial HMO, Commercial PPO, MMCP, EP)

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, EP)

1. How often did your health plan handle your claims quickly?
2. How often did your health plan handle your claims correctly?

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 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. The following questions are contained in this composite: (Commercial HMO, Commercial PPO, MMCP, EP)

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 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. (Commercial HMO, Commercial PPO, MMCP, EP)

Shared Decision Making

The percentage of members responding "definitely yes" when asked a set of questions to identify if they made healthcare decisions with their doctor. This measure was not collected for 2022 Medicaid Manage Care Plans (MMCP); 2021 MMCP data is presented in this report. The following questions are contained in this composite: (MMCP)

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. This measure was not collected for 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. (Commercial HMO, Commercial PPO, MMCP, EP)

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 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. (MMCP)

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 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. (Commercial HMO, Commercial PPO, MMCP, EP)

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 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. (MMCP)

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 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. (MMCP)

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. This measure was not collected for 2022 Medicaid Managed Care Plans (MMCP); 2021 MMCP data is presented in this report. The following questions are contained in this composite: (MMC/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: (MMC/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. (MMC/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: (MMC/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. (MMC/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: (MMC/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?

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: (MMC/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. (MMC/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?" (Commercial HMO, Commercial PPO, MMCP, EP)

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?" (MMC/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. (Commercial HMO, Commercial PPO, MMCP, EP)

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: (MMC/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.