New York State Coalition of Prepaid Health Services Plans: New Report Shows New York's Medicaid Managed Care Program Improves Quality of Care While Containing Costs.

Business Editors/Health/Medical Writers

NEW YORK--(BUSINESS WIRE)--Jan. 14, 2004

Exceeds National Quality Benchmarks in Women's Healthcare, Child

and Adolescent Healthcare, Chronic Care of Adults, and Treatment of

Mental Illness

New York State's Medicaid managed care program has improved the quality of healthcare for low-income New Yorkers while reducing the rate of Medicaid cost growth, according to a report released today by the New York State Coalition of Prepaid Health Services Plans. The report, titled "Medicaid Managed Care in New York: A Public-Private Partnership that Works," was prepared by the law and consulting firm Manatt, Phelps & Phillips, LLP, counsel to the coalition of 15 health plans, serving the majority of New York's 1.7 million Medicaid managed care enrollees.

The report's joint findings are especially timely as the state struggles to address rising Medicaid costs without compromising access to critical healthcare services. Governor Pataki launched New York State's mandatory Medicaid managed care program in 1997 with bipartisan support in an effort to save the state and local governments money relative to the fee-for-service system, while improving access to primary care providers, coordinating care for chronic conditions, and monitoring and improving healthcare quality. There is now documented evidence that the program is advancing the state's quality and financial goals.

The Coalition's report reveals that New York's Medicaid managed care program has made demonstrable, often dramatic, quality improvements over Medicaid fee-for-service in New York in 11 out of 13 areas, including general primary care utilization rates, rates at which women get Pap smears and children get immunized, prenatal and postpartum visit rates, and the management of chronic conditions like diabetes. The program also exceeds nine out of 10 national quality benchmarks for Medicaid managed care established by the American Public Human Services Association, in such areas as women's healthcare, child and adolescent healthcare, chronic care of adults, and treatment of mental illness.

Even as New York's Medicaid managed care program has improved healthcare quality, its per-enrollee costs have grown at a slower rate than Medicaid fee-for-service. From 2000 to 2002, New York Medicaid managed care per-enrollee costs increased a total of 2.3 percent, while comparable per-enrollee costs in Medicaid fee-for-service grew more than twice as fast at 4.9 percent.

"Coalition plans are proud of the improvements in public health reflected in this report, and we're committed to further enhancing healthcare access and quality for low-income New Yorkers in the years ahead," said Harris Lampert, MD, chairman of the Coalition and president of Community Premier Plus, a private, not-for-profit health plan that serves medically underserved communities in Manhattan and the Bronx. "While there is much more to be done, the success of this public-private partnership is a clear example of the level of quality that can be achieved through publicly subsidized health programs."

The report was developed with data from the 2001 and 2002 National Committee for Quality Assurance Medicaid Healthplan Employer Data and Information Set (HEDIS) measures, the 2001 and 2002 New York State Quality Assurance Reporting Requirements (QARR) for managed care plans, and a 2000 New York State Medicaid Fee-for-Service HEDIS/QARR study by the Island Peer Review Organization (IPRO) released in 2003. Manatt also utilized Medicaid databases maintained by the New York State Department of Health.

"This report demonstrates that we can provide quality healthcare benefits to New York's Medicaid enrollees while still containing costs," said Deborah Bachrach, an attorney and co-chair of the Health Care Group at Manatt, Phelps & Phillips. "As the state looks to build on the Medicaid quality gains described in our research, it is clear that these health plans will continue to be critically important partners."

According to the Coalition report, Medicaid managed care has significantly improved women's health in New York. For example, while fewer than 40 percent of women in the fee-for-service system receive an annual Pap smear, over 70 percent of women in managed care are screened. Medicaid managed care has also improved the rate of well-care and preventive care visits for adolescents, with 64 percent visiting a doctor annually, compared with 47 percent of fee-for-service enrollees. In addition, 64 percent of children enrolled in Medicaid managed care receive childhood immunizations, compared with 50 percent of those enrolled in the fee-for-service program. Significant improvements have also been made in diabetes management and the treatment of mental illness.

About the New York State Coalition of Prepaid Health Services Plans

The 15 members of the New York State Coalition of Prepaid Health Services Plans serve the majority of the state's Medicaid managed care enrollees. Sponsored by public and non-profit hospitals and community health centers and physicians, these plans have been serving New York's Medicaid managed care enrollees for more than a decade.

Coalition members include: ABC Health Plan, Affinity Health Plan, CenterCare, The Community Choice Health Plan, Community Premier Plus, Fidelis Care New York (NY State Catholic Health Plan), HealthFirst PHSP, Health Plus PHSP, Hudson Health Plan, MetroPlus Health Plan, The Monroe Plan for Medical Care, Neighborhood Health Providers, New York-Presbyterian Community Health Plan, Partners in Health and Total Care (Syracuse PHSP).

About Manatt, Phelps & Phillips, LLP

Manatt, Phelps & Phillips, LLP, provides comprehensive legal and consulting services to domestic and international clients from offices in New York; California; Washington, D.C.; and Mexico City. Manatt has particular expertise in the complex financial, regulatory, and operational challenges confronting healthcare entities. For more information, visit www.manatt.com.

To receive a copy of the full report, "Medicaid Managed Care in New York: A Public-Private Partnership that Works," please contact Patricia Boozang, senior health policy analyst at Manatt, Phelps & Phillips, LLP, at 212-830-7237 or [e-mail].