Dec 17, 2018
MetroPlus Health Plan has earned an overall rating of five stars, the highest possible score, in the New York State Department of Health’s newly released “2018 Consumer’s Guide to Medicaid and Child Health Plus Managed Care Plans in New York City.” The State’s guide is an annual rating of managed care plans on quality of care delivered and members’ satisfaction with the care and services they receive.
“This outstanding result is another indication of the superior healthcare and coverage that MetroPlus members receive and is reflective of the excellent MetroPlus provider network that puts quality healthcare—and our members—first,” said Dr. Arnold Saperstein, President and CEO of MetroPlus.
The health plan’s 2018 five-star overall rating is an improvement from its 4-star overall rating in 2017. The clinical areas of Cardiovascular Care, Diabetes Care, and Child and Adolescent Care all improved to five stars this year. Last year, MetroPlus received five stars in Women’s Preventive Care and Adult Care, and this year repeated by receiving five stars again in both those clinical areas.
The “2018 Consumer’s Guide” rates plans on 10 distinct measures across three categories—Preventive and Well-Care for Adults and Children, Quality of Care Provided to members with Illnesses, and Patient Satisfaction with Access and Services—ultimately resulting in an Overall Rating of 0 to 5 stars. Ratings are based on a comparison of plan rates to statewide averages. Quality ratings are from information submitted by health plans. Patient satisfaction ratings are from a member survey conducted for the Department of Health. Results for measures involving children and adolescents are based on members of both Medicaid and Child Health Plus. The complete “2018 Consumer’s Guide” can be found at
MetroPlus attributes its five-star rating, a feat shared by only one other plan in New York City, to a number of factors, including:
Focusing on Quality Management
The MetroPlus Quality Management Department has been at the forefront of the health plan’s continuously improving quality measure scores. Providing convenient access to care through community events hosted by the Quality Management team, for example, helped the plan close gaps in care for measures such as dental and diabetic eye screenings, as well as critical completion of flu shots. MetroPlus also increased member and provider education and participation in closing gaps in care by modernizing outreach through texting programs and ongoing social media postings. The plan also strategically retained some traditional outreach methods, such as mailings and personalized telephonic outreach, that that have worked well in engaging some members.
Rewarding Members for Completing Healthy Activities
Another factor in increased member satisfaction and quality of care was the plan’s Member Rewards Program, launched in 2017. The Member Rewards Program enables members to earn points, redeemable for premium items, by completing essential healthcare services such as well-visits, colonoscopies, medication adherence, and more, as well as healthy activities such as the Step-Up Challenge, through which members work to increase their physical activity and track their efforts. Significant improvement in member completion of required health screenings made a substantial impact on the standardized performance measures that directly affect the overall rating.
Improving Communications Between Departments
Enhanced communications between departments was also key to the MetroPlus high ranking. This includes sharing responsibilities for improvement interventions between Quality Management, Integrated Care Management, Partnership in Care (for HIV-positive and transgender members), Behavioral Health, and Pharmacy to name some of the essential Medical Management departments.
“Credit has to go to the entire team at MetroPlus,” Dr. Saperstein said. “Without the dedication and hard work done by each and every one of our staff, as well as our partners throughout NYC Health + Hospitals, we would not have topped the rankings this way. Our team is the reason we earned our stars.”