Conroy MB, Butch JM, Bubniak P, Anarella J, Gesten F; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1999; 16: 249-50.
Bureau of Quality Managment and Outcomes Research, Office of Managed Care, New York State Department of Health, Albany 12237, USA.
RESEARCH OBJECTIVE: Since 1994, the New York State Department of Health has collected annual performance data from managed care plans for their Medicaid and commercial HMO enrollees. The Quality Assurance Reporting Requirements (QARR), largely based on the National Committee of Quality Assurance's (NCQA) HEDIS, consist of quality, utilization, access and descriptive information. QARR also includes additiona; NYS-specific measures of particular importance to New York State residents, such as leas screening. This paper will examine, for selected quality measures, which attributes were associated with plan performance in 1996 and 1997. STUDY DESIGN: Self-reported, audited plan data were analyzed using univariate methods of stratification. Rates were weighted by plan enrollment and do not include plans that failed an independent audit. The following attributes were analyzed for both the Medicaid and Commercial populations: Plan profit status (For Profit, Not For Profit); Prepaid Health Service Plan (PHSP) versus non-PHSP (Medicaid only); Geographical Designation (New York City, Upstate, Downstate); Affiliation (National, New York State); Size (number of enrollees); Plan method for collecting data (Administrative, Medical Record Review, or a combination [Hybrid]). PRINCIPAL FINDINGS: While the publication of QARR data has provided the framework for evaluating plan performance, secondary analyses have also revealed some interesting results. For example, in 1997, not-for-profit managed care plans had higher rates than for-profit plan on selected commercial quality measures. Commercial HMOs tended to have higher Medicaid rates than Medicaid-only (PHSPs). CONCLUSIONS: Aggregate performance rates by plan attribute indicate that rates tend to differ by attribute analyzed on a selected group of effectiveness of care measures. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: The analysis will provide insight into the effect certain attributes have on plan performance with the QARR quality measures.
Publication Types:
Keywords:
- Health Benefit Plans, Employee
- Health Facilities, Proprietary
- Health Maintenance Organizations
- Managed Care Programs
- Medicaid
- New York
- New York City
- Risk Adjustment
- Total Quality Management
- economics
- methods
- organization & administration
- hsrmtgs
Other ID:
UI: 102193721
From Meeting Abstracts