As a way of monitoring managed care plan performance and improving the quality of care provided to New York State residents, the New York State Department of Health (NYSDOH) collects data for four types of managed care insurance (commercial HMO, commercial Preferred Provider Organization, Medicaid managed care, and Child Health Plus) on an annual basis.

This map shows the total incentive payments disbursed to Eligible Professionals (EPs) and Eligible Hospitals (EHs) by county beginning in 2011, through the NY Medicaid Electronic Health Records (EHR) Incentive Program, a CMS Promoting Interoperability Program. The darker shading represents the counties that have received the most payments.
Authorized by the American Recovery and Reinvestment Act (ARRA) of 2009, this program provides multi-year financial incentives to EPs and EHs who adopt, implement, or upgrade, and subsequently demonstrate meaningful use, of Certified Electronic Health Record Technology (CEHRT).
For more information please visit: https://www.health.ny.gov/ehr.

The datasets contain number of Medicaid PQI hospitalizations (numerator), county Medicaid population (denominator), observed rate, expected number of hospitalizations and rate, and risk-adjusted rate for Agency for Healthcare Research and Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid enrollees beginning in 2011.

The dataset contains Potentially Preventable Readmission observed, expected, and risk adjusted rates by hospital for Medicaid enrollees beginning in 2011.

The datasets contain number of Medicaid PQI hospitalizations (numerator), county Medicaid population (denominator), observed rate, expected number of hospitalizations and rate, and risk-adjusted rate for Agency for Healthcare Research and Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid enrollees beginning in 2011.

Note: The final update to this dataset was on 7/31/2023. The dataset is representative of financial incentive payments disbursed to Eligible Professionals (EPs) and Eligible Hospitals (EHs) by the NY Medicaid Electronic Health Records (EHR) Incentive Program, a CMS Promoting Interoperability Program. Authorized by the American Recovery and Reinvestment Act (ARRA) of 2009, this program provides multi-year financial incentives to EPs and EHs who adopt, implement, or upgrade, and subsequently demonstrate meaningful use of Certified Electronic Health Record Technology (CEHRT).

This dataset includes Medicaid Managed Care, Commercial HMO, and Commercial PPO performance data from the Quality Assurance Reporting Requirements (QARR) by member demographic characteristics. QARR is largely based on measures of quality developed and published by the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®). Plans are required to submit quality performance data each year. Demographic information analyzed in this report includes members’ sex, age, race/ethnicity, Medicaid aid category, cash assistance status, behavioral health conditions including serious mental illness (SMI) and substance use disorder (SUD), payer status, and region of residence. Measuring the quality of care, and the ability to measure disparities in care is an important first step to a better understanding of the underlying factors that drive differences in care among certain populations within Medicaid Managed Care, Commercial HMO, and Commercial PPO.
These data are published annually for Medicaid Managed Care in the Health Care Disparities in New York State Report and on the NYSDOH web site: https://www.health.ny.gov/health_care/managed_care/reports/

This data set contains information on selected chronic health conditions in the Medicaid population at the zip code level. The chronic health conditions were identified through 3M Clinical Risk Group software and Medicaid enrollment/eligibility, encounter, claim and pharmacy data over a 12-month period.

This data set contains statewide Medicaid beneficiary counts by valid NYS five-digit zip code. Also in this file are counts of beneficiaries who are dual eligible for Medicaid and Medicare, total inpatient admissions, and total emergency room visits.

This dataset contains institutional provider data. The primary purpose for the Provider Network Data System is to collect data needed to evaluate the provider networks including physicians, hospitals, labs, home health agencies, durable medical equipment providers, etc., for all types of Managed Care plans in New York State, including HIV Special Need Plans (SNP), Family Health Plus (FHP) Buy-In, Programs of All-Inclusive Care for the Elderly (PACE), and Non-PACE Managed Long-Term Care (MLTC) plans. For more information, check out: http://www.health.ny.gov/health_care/managed_care/.

The primary purpose for the Provider Network Data System is to collect data needed to evaluate the provider networks including physicians, hospitals, labs, home health agencies, durable medical equipment providers, etc., for all types of Managed Care plans in New York State, including HIV Special Need Plans (SNP), Family Health Plus (FHP) Buy-In, Programs of All-Inclusive Care for the Elderly (PACE), and Non-PACE Managed Long-Term Care (MLTC) plans.

This dataset reflects institutional provider data.

Provider Network Data System information is self-reported.

For more information, check out http://www.health.ny.gov/health_care/managed_care/.

The primary purpose for the Provider Network Data System is to collect data needed to evaluate the provider networks including physicians, hospitals, labs, home health agencies, durable medical equipment providers, etc., for all types of Managed Care plans in New York State, including HIV Special Need Plans (SNP), Family Health Plus (FHP) Buy-In, Programs of All-Inclusive Care for the Elderly (PACE), and Non-PACE Managed Long-Term Care (MLTC) plans. This dataset reflects individual provider data. Provider Network Data System information is self-reported. For more information, check out: http://www.health.ny.gov/health_care/managed_care/.

This dataset aggregates and displays the number of New York State Medicaid enrollees by eligibility year and month within each NYS Economic Region, health insurance plan information, and enrollee demographics.

This dataset contains individual provider netowrk data.The primary purpose for the Provider Network Data System is to collect data needed to evaluate the provider networks including physicians, hospitals, labs, home health agencies, durable medical equipment providers, etc., for all types of Managed Care plans in New York State, including HIV Special Need Plans (SNP), Family Health Plus (FHP) Buy-In, Programs of All-Inclusive Care for the Elderly (PACE), and Non-PACE Managed Long-Term Care (MLTC) plans. For more information, check out: http://www.health.ny.gov/health_care/managed_care/.

The primary purpose for the Provider Network Data System is to collect data needed to evaluate the provider networks including physicians, hospitals, labs, home health agencies, durable medical equipment providers, etc., for all types of Managed Care plans in New York State, including HIV Special Need Plans (SNP), Family Health Plus (FHP) Buy-In, Programs of All-Inclusive Care for the Elderly (PACE), and Non-PACE Managed Long-Term Care (MLTC) plans.

This dataset reflects individual provider data.

Provider Network Data System information is self-reported.

For more information, check out http://www.health.ny.gov/health_care/managed_care/.

This dataset contains information on selected chronic health conditions in the Medicaid population at the county level. The chronic health conditions were identified through 3M Clinical Risk Group software and Medicaid enrollment/eligibility, encounter, claim and pharmacy data over a 12-month period.

The primary purpose for the Provider Network Data System is to collect data needed to evaluate the provider networks including physicians, hospitals, labs, home health agencies, durable medical equipment providers, etc., for all types of Managed Care plans in New York State, including HIV Special Need Plans (SNP), Family Health Plus (FHP) Buy-In, Programs of All-Inclusive Care for the Elderly (PACE), and Non-PACE Managed Long-Term Care (MLTC) plans.

This dataset reflects institutional provider data.
Provider Network Data System information is self reported. For more information, go to http://www.health.ny.gov/health_care/managed_care/.

The datasets contain number of Medicaid PDI hospitalizations (numerator), county or zip Medicaid population (denominator), observed rate, expected number of hospitalizations and rate, and risk-adjusted rate for Agency for Healthcare Research and Quality Pediatric Quality Indicators – Pediatric (AHRQ PDI) for Medicaid enrollees beginning in 2011. The Agency for Healthcare Research and Quality (AHRQ) Pediatric Quality Indicators (PDIs) are a set of population based measures that can be used with hospital inpatient discharge data to identify ambulatory care sensitive conditions. These are conditions where 1) the need for hospitalization is potentially preventable with appropriate outpatient care, or 2) conditions that could be less severe if treated early and appropriately. Both the Urinary Tract Infection and Gastroenteritis PDIs include admissions for patients aged 3 months through 17 years. The asthma PDI includes admissions for patients aged 2 through 17 years. Eligible admissions for the Diabetes Short-term Complications PDI includes admissions for patients aged 6 through 17 years.

The primary purpose for the Provider Network Data System is to collect data needed to evaluate the provider networks including physicians, hospitals, labs, home health agencies, durable medical equipment providers, etc., for all types of Managed Care plans in New York State, including HIV Special Need Plans (SNP), Family Health Plus (FHP) Buy-In, Programs of All-Inclusive Care for the Elderly (PACE), and Non-PACE Managed Long-Term Care (MLTC) plans. This dataset reflects institutional provider data. Provider Network Data System information is self reported. For more information, go to http://www.health.ny.gov/health_care/managed_care/.

The datasets contain number of Medicaid PDI hospitalizations (numerator), county or zip Medicaid population (denominator), observed rate, expected number of hospitalizations and rate, and risk-adjusted rate for Agency for Healthcare Research and Quality Pediatric Quality Indicators – Pediatric (AHRQ PDI) for Medicaid enrollees beginning in 2011.

This dataset contains Potentially Avoidable Antibiotic Prescribing observed and risk-adjusted rates for adult Medicaid enrollees by provider county beginning in 2010.

Potentially Avoidable Antibiotic Prescriptions are antibiotic prescriptions filled for the treatment of acute respiratory infections for which antibiotics are not indicated, contributing to bacterial drug resistance. Index visits for acute respiratory infections and corresponding prescription fills were identified through the use of previously published methods.

The rates were calculated using Medicaid outpatient claims and encounters, and prescription drug data.

The observed and risk adjusted rates are presented by provider county (including a statewide total).

This dataset includes Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the Delivery System Reform Incentive Payment (DSRIP) Program. The DSRIP program will promote community-level collaborations and focus on system reform, specifically a goal to achieve a 25 percent reduction in avoidable hospital use over five years. As a part of the DSRIP program, Performing Provider System will employ multiple projects both to transform health care delivery as well as to address the broad needs of the population that the performing provider system serves. These projects described in Attachment J are grouped into different strategies, such as behavioral health, within each Domain (System Transformation Projects (Domain 2), Clinical Improvement Projects (Domain 3), and Population-wide Projects (Domain 4). For each strategy, there is a set of metrics that the performing provider system will be responsible for if they do any one of the projects within that strategy. This dataset includes only Domain 3 Clinical Metrics.

The primary purpose for the Provider Network Data System is to collect data needed to evaluate the provider networks including physicians, hospitals, labs, home health agencies, durable medical equipment providers, etc., for all types of Managed Care plans in New York State, including HIV Special Need Plans (SNP), Family Health Plus (FHP) Buy-In, Programs of All-Inclusive Care for the Elderly (PACE), and Non-PACE Managed Long-Term Care (MLTC) plans.

This dataset reflects institutional provider data.
Provider Network Data System information is self reported. For more information, go to http://www.health.ny.gov/health_care/managed_care/.