Impact of New York State's Medicaid Breast Cancer Selective Contracting Policy on Access and Quality of Care Outcomes.

The New York State Medicaid Breast Cancer Selective Contracting policy was implemented in 2009 and mandates that Medicaid enrollees receive breast cancer surgery at high-volume hospital and ambulatory surgery facilities. This article evaluates the policy's impact on 8 access and quality of care measures prepolicy and postpolicy implementation. Linked New York State (NYS) Cancer Registry, Statewide Planning and Research Cooperative System, and NYS Medicaid encounter and claim data were used to calculate measures.

Paying for Outcomes in Medicaid: The Time Is Now.

Medicaid can improve quality and reduce costs by adopting a transparent quality measurement system based on outcomes that will improve quality and reduce costs.

Improving Adjuvant Hormone Therapy Use in Medicaid Managed Care-Insured Women, New York State, 2012-2014.

Introduction: In 2010, national guidelines recommended that women with nonmetastatic, hormone receptor-positive breast cancer take adjuvant hormone therapy for 5 years. As results from randomized clinical trials became available, guidelines were revised in 2014 to recommend 10 years of therapy. Despite evidence of its efficacy, low initiation rates have been documented among women insured by New York State Medicaid.

High Intensity of End-of-Life Care Among Adolescent and Young Adult Cancer Patients in the New York State Medicaid Program.

Background: Little is known about the care that adolescent and young adult (AYA) cancer patients receive at the end of life (EOL).

Objective: To evaluate use of intensive measures and hospice and location of death of AYA cancer patients insured by Medicaid in New York State.

Design: Using linked patient-level data from the New York State Cancer Registry and state Medicaid program, we identified 705 Medicaid patients who were diagnosed with cancer between the ages of 15 and 29 in the years 2004-2011, who subsequently died, and who were continuously enrolled in Medicaid in the last 60 days of life.

Underuse of hospice care by Medicaid-insured patients with stage IV lung cancer in New York and California.

Purpose: Medicare patients with advanced cancer have low rates of hospice use. We sought to evaluate hospice use among patients in Medicaid, which insures younger and indigent patients, relative to those in Medicare.

Patients And Methods: Using linked patient-level data from California (CA) and New York (NY) state cancer registries, state Medicaid programs, NY Medicare, and CA Surveillance, Epidemiology, and End Results-Medicare data, we identified 4,797 CA Medicaid patients and 4,001 NY Medicaid patients ages 21 to 64 years, as well as 27,416 CA Medicare patients and 16,496 NY Medicare patients ages ≥ 65 years who were diagnosed with stage IV lung cancer between 2002 and 2006.

Initiation of adjuvant hormone therapy by Medicaid insured women with nonmetastatic breast cancer.

Hormone therapy is the mainstay of adjuvant treatment for hormone receptor positive (HR-positive) nonmetastatic breast cancer. We evaluated adjuvant hormone therapy (AHT) initiation among Medicaid-insured women aged 21-64 years with stage I-III HR-positive breast cancer. We used multivariable logistic regression to identify independent predictors of AHT initiation.

Preventive care for chronically ill children in medicaid managed care.

Objectives: To determine whether there is an association between the quality of child preventive care received and the existence of 1 or more chronic conditions.

Study Design: A retrospective study of all New York State children and adolescents enrolled in Medicaid managed care in 2008.

Methods: Using a cohort identified through mandatory annual quality reporting, a clinical algorithm was applied to administrative data to assign children to 3 health status levels: healthy/ acute, minor chronic, and significant chronic.

Cancer disparities in the context of Medicaid insurance: a comparison of survival for acute myeloid leukemia and Hodgkin's lymphoma by Medicaid enrollment.

Background: Because poverty is difficult to measure, its association with outcomes for serious illnesses such as hematologic cancers remains largely uncharacterized. Using Medicaid enrollment as a proxy for poverty, we aimed to assess potential disparities in survival after a diagnosis of acute myeloid leukemia (AML) or Hodgkin's lymphoma (HL) in a nonelderly population.

Methods: We used records from the New York (NY) and California (CA) state cancer registries linked to Medicaid enrollment records for these states to identify Medicaid enrolled and nonenrolled patients aged 21-64 years with incident diagnoses of AML or HL in 2002-2006.

Building capacity to assess cancer care in the Medicaid population in New York State.

Objective: To link data from a central cancer registry with Medicaid enrollment and claims files in order to assess cancer care in an economically disadvantaged population.

Data Sources: Over 500,000 cancer patients diagnosed between 2002 and 2006 reported to the New York State Cancer Registry were linked with New York State Medicaid enrollment and claims records.

Study Design: A probabilistic linkage was performed between the two data sources.

Can prenatal care impact future well-child visits? The experience of a low income population in New York State Medicaid managed care.

To examine the association between maternal characteristics and care patterns and the subsequent utilization of well-child visits in a low income population in New York State (NYS). We analyzed Medicaid managed care birth data from 2004 to 2005 linked to an administrative database to obtain information on preventive well-care visits for the child. The outcome variable was whether the child had five or more well-child visits (WCVs) in their first 15 months of life.

Bariatric surgery for obesity: surgical approach and variation in in-hospital complications in New York State.

Background: The purpose of this study was to demonstrate the relationship between the surgical approach employed for adults undergoing bariatric surgery for obesity in New York State and in-hospital postoperative complications. Understanding the differences among surgical approaches in terms of the type, extent, and likelihood of postoperative complications and the patient characteristics associated with them, particularly as the annual volume of bariatric surgery increases, can inform decisions about the appropriate bariatric surgical approach for patients with particular characteristics.

Methods: Using New York's inpatient hospital discharge database, we identified 8,413 adults who underwent a bariatric surgical procedure during calendar year 2006.

Integration of data and management tools into the new york state medicaid managed care encounter data system.

The New York State Department of Health has created a data warehouse to analyze and evaluate the Medicaid managed care program. Online query tools and reports, grouping tools such as Diagnostic Related Groups, and measurement tools such as Health Plan Data and Information Set (HEDIS) measures have been incorporated into the data warehouse. Other public health data sets including birth certificate data have also been integrated.

Quality measurement in medicaid managed care and fee-for-service: the New York State experience.

New York State has transitioned 1.7 million Medicaid recipients from a fee-for-service delivery system to a managed care model. To evaluate whether managed care has had a positive effect on access and quality, the New York State Department of Health compared rates of performance across standardized measures of quality (ie, childhood immunization, well-child visits, prenatal care in the first trimester, cervical cancer screening, use of appropriate medications for people with asthma, and comprehensive diabetes care) in both systems.

Identifying areas for improvement: results of a Medicaid managed care diabetes survey.

This study explores factors that contribute to dissatisfaction for Medicaid managed care enrollees with diabetes. Using results from a mail survey of 2,104 Medicaid managed care enrollees with diabetes, multivariate logistic regression models were fit for 3 outcomes: dissatisfaction with diabetes information from doctor or nurse, dissatisfaction with diabetes care received and dissatisfaction with health plan. Across the 3 models, enrollees who reported they were in poor health, who failed to engage in self-management activities, who reported little or inadequate patient education and/or who had difficulty accessing diabetes care were more likely to report dissatisfaction.

Asthma in Medicaid managed care enrollees residing in New York City: results from a post-World Trade Center disaster survey.

The collapse of the World Trade Center on September 11, 2001, released a substantial amount of respiratory irritants into the air. To assess the asthma status of Medicaid managed care enrollees who may have been exposed, the New York State Department of Health, Office of Managed Care, conducted a mail survey among enrollees residing in New York City. All enrollees, aged 5-56 with persistent asthma before September 11, 2001, were surveyed during summer 2002.

Quality oversight and improvement in Medicaid managed care.

New York State has been collecting performance data from managed care plans that serve the Medicaid population since 1993. The data come to the state via the Quality Assurance Reporting Requirements--a series of quality of care, access, and utilization measures, largely based on the Health Plan Employer Data and Information Set, as well as several New York State-specific measures. In addition to collecting the data, the state publishes the information, works with plans that have below average rates of performance and provides a number of program and financial rewards to plans for rates that demonstrate high quality care.

Validation of birth certificate data in New York State.

Vital statistics birth certificate data are an important source of information for researchers, policy makers, and state officials to evaluate the quality of care delivered to pregnant women. The purpose of this study was to assess the validity of data elements being reported by the hospitals on the birth certificate record when compared to the medical record. This study used a random sample of birth certificates from two upstate and two downstate counties, in New York State, comprising a total of 100 records per county.

Do commercial managed care members rate their health plans differently than Medicaid managed care members?

Objective: To determine if members of commercial managed care and Medicaid managed care rate the experience with their health plans differently.

Data Sources: Data from both commercial and Medicaid Consumer Assessment of Health Plan Surveys (CAHPS) in New York State.

Study Design: Regression models were used to determine the effect of population (commercial or Medicaid) on a member's rating of their health plan, controlling for health status, age, gender, education, race/ethnicity, number of office visits, and place of residence.

The quality performance matrix: New York State's model for targeting quality improvement in managed care plans.

This article describes a methodology developed by the New York State Department of Health to analyze health plan performance data using two benchmarks: comparison to peers and comparison to historic results. It explains how that analysis is used to target quality improvement. Through this process the department effectively partners with health plans to foster improvement by identifying problems and barriers, encouraging health plans to set performance goals, and then working with health plans to design action plans to address the barriers.