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MetroPlusHealth Ranks #1 in 2020 Medicaid Quality Incentive Program

Outperforms All New York Health Insurance Plans in New York State Quality Incentive Rankings

Jul 14, 2021

New York, NY

In a year that saw unprecedented challenges within the entire health care community, MetroPlusHealth, New York City’s Health Plan, was ranked number one among all 15 New York State Medicaid plans in overall quality, according to the New York State Department of Health’s 2020 Quality Incentive results. “While we have consistently scored high in quality, having achieved the #1 spot during a global pandemic speaks volumes about the dedicated people at our company who rose to the occasion,” said Dr. Talya Schwartz, President & CEO of MetroPlusHealth.

As New York City shut down in March of 2020, the staff of MetroPlusHealth pivoted to remote work as entire departments were redeployed. As part of Covid-19 operations, while family, friends and co-workers were dealing with personal challenges as a result of the spreading virus, new protocols were put into place and support and communications to members were intensified. “Navigating through unchartered territories was key during this time,” said Dr. Schwartz. “We were there for our members assisting with needed care, Covid-19 testing, and day to day essentials. It was during this time that our membership surged by 15% to over 600,000 and then continued growing to over 620,000 members this year,” she added.

Key factors contributing to the top ranking, where MetroPlusHealth scored above 90% of State benchmarks, included care related to diabetes, hypertension, substance abuse disorders and mental illness. The plan cites its streamlined process of working with NYC Health + Hospitals and its community providers in exchanging data, education, member support, and working to bring members in for care, especially those with highest and most immediate needs. The New York State Quality Incentive program is based on reporting and measurement from medical care in the prior calendar year. A plan’s score and ranking in the program indicates the quality of care provided to the plan’s members relative to all plans in the Medicaid Managed Care market. The data evaluated considers national standards of care, State specific measures and consumer input and assessment.

Rates of performance in Medicaid managed care have increased steadily over the last decade. New York State Medicaid plans have demonstrated a high level of care compared to national averages, and for many domains of care the gap in performance between commercial coverage and Medicaid managed care has been decreasing and, in some cases, has been completely closed since the Quality Incentive Program was implemented.

“Just a few months ago,” Dr. Schwartz said, “we and other Medicaid Managed Care plans were concerned about the viability of this program given some of the State cuts. Fortunately, some of those cuts were partially restored and allowed us and others to continue to focus on quality and adherence to standards of care for our members.” Partial restoration of State funding also allowed MetroPlusHealth to support the provider community, through monetary means, as well as operationally, to create and sustain the infrastructure and the personnel needed to focus on this aspect of care delivery. “We could not be prouder of our team and our provider partners,” Dr. Schwartz stated. “We are grateful to the MetroPlusHealth staff who once again demonstrated the enormous value of MetroPlusHealth and the Health + Hospitals’ system to all New Yorkers.”