Very large per-capita Medicaid population.
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1 MEDICAID INSTITUTE AT UNITED HOSPITAL FUND Medicaid Regional Data Compendium, 214 Chartbook 2: New York City This chartbook is part of a broader data compendium from the Medicaid Institute at United Hospital Fund. It presents data on the demographics, service usage, and quality measures for Medicaid beneficiaries from New York City. The chartbook is based on data for the Medicaid population residing in the city, regardless of where they receive care; it is not a comprehensive look at care provided in New York City. For details on data elements, please see the accompanying methods and sources. Medicaid Regional Data Compendium, 214 was prepared by Lee Kennedy-Shaffer and Chad Shearer of the Medicaid Institute at United Hospital Fund. The entire publication is available at and Funded by the New York State Department of Health. Very large per-capita Medicaid population. Higher share of older beneficiaries and lower share of younger beneficiaries than the state as a whole. Unadjusted inpatient admission rate slightly higher than the statewide average. Rate of potentially avoidable hospitalizations (PQIs) for adult acute conditions better than risk-adjusted expectations (and below statewide averages). PQIs for adult chronic conditions worse than risk-adjusted expectations (and above statewide averages). PQIs for children worse than risk-adjusted expectations for nearly all selected indicators, especially gastroenteritis and asthma. Fewer potentially preventable emergency room visits than the risk-adjusted expectation. Summary Data for New York City Counties Bronx, Kings (Brooklyn), New York (Manhattan), Queens, Richmond (Staten Island) Total Population as of July 1, 213 8,45,837 Medicaid Beneficiaries with a Claim in 213 3,142,548 (37.4% of Total Population) Medicaid Claims in ,261,164 (56.1 Claims per Beneficiary) Medicaid Beneficiaries Enrolled in Managed Care 2,13,659 (66.9% of Medicaid Beneficiaries) Mainstream Managed Care Plans: Affinity Health Plan, Amerigroup, Amida Care, HealthFirst PHSP, HIP of Greater New York, MetroPlus, NYS Catholic Health Plan, United Healthcare Plan, VNS Choice, WellCare Managed Long-Term Care Plans: Aetna Better Health, AgeWell New York, AlphaCare, Amerigroup, ArchCare Community Life, ArchCare Senior Life, CCM Select, s Plan for Healthy Living, Comprehensive Care Management, ElderPlan, ElderServe, Extended MLTC, Fidelis Care at Home, GuildNet, HHH Choices, HIP of Greater New York, Independence Care Systems, Integra, MetroPlus, Montefiore HMO, North Shore-LIJ Health Plan, Senior Health Partners, Senior Whole Health, United Healthcare, Village Care, VNS Choice, WellCare Health Homes in the City: Bronx Accountable Healthcare Network Health Home (BAHN), Bronx-Lebanon Hospital, Community Health Care Network, Coordinated Behavioral Care dba Pathways to Wellness, Heritage Health and Housing Home Network, New York City Health and Hospitals Corporation, North Shore Long Island Jewish Health Home, Queens Coordinated Care Partners, Southwest Brooklyn Health Home dba Brooklyn Health Home (Maimonides), St. Luke s Roosevelt Hospital dba Mount Sinai Health Home, The New York and Presbyterian Hospital, Visiting Nurse Service of New York Home Care dba Community Care Management Partners (CCMP) NOVEMBER 214
2 Characteristics of Medicaid Beneficiaries Medicaid Beneficiaries by Age Group 4% 35% 3% Percentage of Beneficiaries 25% 2% 15% 1% 5% % Medicaid Beneficiaries by Medicare Enrollment Status 9% 8% 7% Percentage of Beneficiaries 6% 5% 4% 3% 2% 1% % No Medicare Medicare New York City State Note: Age group and enrollment status are for Medicaid beneficiaries with a claim in 213. MEDICAID INSTITUTE AT UNITED HOSPITAL FUND 2
3 Diagnosis and Provider Data Top 25 Diagnostic Categories of All-Payer Inpatient Admissions (212) Rank Diagnosis Category Number of Discharges Percent of Discharges Statewide Percentage 1 Liveborn 115, % 9.43% 2 Septicemia (except in labor) 31, % 3.3% 3 Alcohol-related disorders 27, % 1.85% 4 Nonspecific chest pain 27, % 1.93% 5 Schizophrenia and other psychotic disorders 24, % 1.69% 6 Mood disorders 24, % 2.49% 7 Asthma 23, % 1.5% 8 Congestive heart failure; nonhypertensive 23, % 2.28% 9 Other complications of birth; puerperium affecting management of mother 21, % 1.61% 1 Pneumonia (except that caused by tuberculosis or sexually transmitted disease) 21, % 2.19% 11 Substance-related disorders 2, % 1.58% 12 Diabetes mellitus with complications 2, % 1.52% 13 Coronary atherosclerosis and other heart disease 2, % 1.67% 14 Cardiac dysrhythmias 2,2 1.78% 2.2% 15 Skin and subcutaneous tissue infections 18, % 1.73% 16 Other complications of pregnancy 17,1 1.51% 1.34% 17 Prolonged pregnancy 16, % 1.18% 18 Rehabilitation care; fitting of prostheses; and adjustment of devices 15, % 1.33% 19 Complication of device; implant or graft 15, % 1.52% 2 Urinary tract infections 14, % 1.36% 21 OB-related trauma to perineum and vulva 14, % 1.26% 22 Epilepsy; convulsions 14, % 1.8% 23 Complications of surgical procedures or medical care 13, % 1.3% 24 Acute cerebrovascular disease 13, % 1.31% 25 Osteoarthritis 12, % 2.5% Total of Top , % 5.25% All Other Diagnoses 536, % 49.75% Total for Region 1,123,87 Top Five Inpatient Providers Serving the Region s Medicaid Beneficiaries (213) Provider Name Number of Claims Number of Unique Patients Percent of Unique Patients Montefiore Medical 75,966 35,58 8.4% New York-Presbyterian 6,756 31,46 7.4% Maimonides Medical 48,112 25,139 6.% Beth Israel Medical 35,968 19,83 4.7% Bronx-Lebanon Hospital 36,586 17, % Total of Top Five Providers 257,388 MEDICAID INSTITUTE AT UNITED HOSPITAL FUND 3
4 Visit Rates (Unadjusted) Emergency Room Visit Rate per 1, Members 6, 5, 4, 3, 2, 1, 1/211 2/211 3/211 4/211 5/211 6/211 7/211 8/211 9/211 1/211 11/211 12/211 1/212 2/212 3/212 4/212 5/212 6/212 7/212 8/212 9/212 1/212 11/212 12/212 1/213 2/213 3/213 4/213 5/213 6/213 7/213 8/213 9/213 1/213 11/213 12/213 Inpatient Admission Rate per 1, Members 2,5 2, 1,5 1, 5 1/211 2/211 3/211 4/211 5/211 6/211 7/211 8/211 9/211 1/211 11/211 12/211 1/212 2/212 3/212 4/212 5/212 6/212 7/212 8/212 9/212 1/212 11/212 12/212 1/213 2/213 3/213 4/213 5/213 6/213 7/213 8/213 9/213 1/213 11/213 12/213 Primary Care Visit Rate per 1, Members 4, 35, 3, 25, 2, 15, 1, 5, 1/211 2/211 3/211 4/211 5/211 6/211 7/211 8/211 9/211 1/211 11/211 12/211 1/212 2/212 3/212 4/212 5/212 6/212 7/212 8/212 9/212 1/212 11/212 12/212 1/213 2/213 3/213 4/213 5/213 6/213 7/213 8/213 9/213 1/213 11/213 12/213 New York City State MEDICAID INSTITUTE AT UNITED HOSPITAL FUND 4
5 Quality Measures Potentially Preventable Emergency Room Visits (Rate per 1, Members) New York City (Observed) New York City (Expected) State (Observed) 33,163 35,417 36,8 Prevention Quality Indicators for Adult Discharges (Hospitalization Rate per 1, Members) 2, 1,8 1,6 1,4 1,2 1, Diabetes Overall Respiratory Overall Circulatory Overall Dehydration UTI Adult Acute Adult Chronic Adult Composite Prevention Quality Indicators for Pediatric Discharges (Hospitalization Rate per 1, Members) Asthma Diabetes Short- Term Gastroenteritis UTI Pediatric Acute Pediatric Chronic Pediatric Composite New York City (Observed) New York City (Expected) State (Observed) Note: All expected rates are standardized for age, sex, and race/ethnicity. Quality measures are annual rates for 212. MEDICAID INSTITUTE AT UNITED HOSPITAL FUND 5
6 DSRIP Project Design Grants Awarded in the Region Provider Name Amida Care, Inc. AW Medical Bronx-Lebanon Hospital Counties Served Bronx, Kings, New York, Queens, Richmond Bronx, Kings, Nassau, New York, Queens Total Award $5, $5, Bronx $5, Conditions Must resubmit with safety net provider as lead or successfully become a safety net provider through the appeal process. Also must demonstrate that you can function as an Integrated Delivery System. Restrict geographic area and clearly demonstrate that network meets requirements. Also, need to demonstrate that providers with the PPS can clinically integrate. Discuss geographic overlap with other PPS and ensure that the PPS is financially sustainable. Lutheran Medical Kings $5, None at this time Maimonides Medical Mount Sinai Hospitals Group Kings, Queens $5, None at this time Bronx, Kings, New York, Queens, Richmond, Westchester New York City Health and Hospitals Corporation Bellevue Hospital Kings, New York, Queens $5, None at this time Public Hospital $285,714 None at this time Coney Island Hospital Kings $285,714 None at this time Elmhurst Hospital Queens $285,714 None at this time Harlem Hospital Bronx, New York $285,714 None at this time Jacobi Medical Bronx $285,714 None at this time Kings County Hospital Kings $285,714 None at this time Woodhull Medical and Mental Health Richmond University Medical and Staten Island University Hospital St. Barnabas Hospital (dba SBH Health System) SUNY Downstate Medical Kings $285,714 None at this time Richmond $5, None at this time Bronx $5, Discuss geographic overlap with other PPS and ensure that the PPS is financially sustainable. Kings $333,333 None at this time The Jamaica Hospital Kings, Queens $5, None at this time The New York and Presbyterian Hospital The New York Hospital Medical of Queens Bronx, Kings, New York, Queens, Westchester $5, None at this time Queens $5, None at this time MEDICAID INSTITUTE AT UNITED HOSPITAL FUND 6
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