New York Moves to Improve
If the Scorecard gave out awards, New York would walk home with the trophy for “Most Improved.” The Empire State, home to about 20 million people, met or exceeded the Scorecard’s threshold for improvement on nearly half the indicators that could be tracked over time (18 of 37) — more than any other state.
New York made strides in four areas of health system performance tracked by the Scorecard
This included a few indicators where the state was among only a handful to make notable progress (see chart).
Some improvements suggest that older New Yorkers may be receiving better care.
Fewer elderly patients received a high-risk drug. In addition, hospital admissions for ambulatory care–sensitive (ACS) conditions, which are generally regarded as potentially preventable with good primary care, were down among Medicare beneficiaries. New York also improved on all three of the Scorecard’s indicators related to nursing home care. This included lowering the percentage of long-stay nursing home residents with a hospital admission, an indicator where only a few states measurably improved.
“New York has undertaken significant reforms to create a high-performing long-term services and supports system, implementing strategies to improve care transitions, support community living, and reduce long nursing home stays and avoidable hospitalizations,” noted the SCAN Foundation in awarding New York a “Pacesetter Prize” last year for progress made in improving the lives of older adults, people with disabilities, and family caregivers.48
What other steps has New York taken?
Even before the Affordable Care Act’s coverage expansions, New York extended Medicaid coverage to parents at higher income levels and to some childless adults. It also prohibited insurers selling plans in the individual market from denying coverage to people with preexisting conditions or from charging them higher premiums. Under the ACA, New York expanded Medicaid eligibility still further and created a state-run insurance marketplace. Between 2013 and 2016, New York’s adult uninsured rate dropped 6 percentage points while the share of adults who skipped needed care because of costs fell 4 points.
Shortly after expanding Medicaid in 2014, the state received federal approval to reinvest savings generated through its Medicaid redesign initiative to implement a Delivery System Reform Incentive Program (DSRIP).
The program, which just wrapped up its third year, aims to improve the way care is delivered and paid for — initially for Medicaid beneficiaries but ultimately for all state residents.49 One of the program’s main goals is to reduce avoidable hospital use by 25 percent within five years. A program within DSRIP called Medicaid Accelerated Exchange, or the MAX project, which deploys multidisciplinary “action teams” to improve care for high utilizers and has shown promising results, may be key to helping the state achieve that goal.50
In addition to DSRIP, New York also is implementing a State Innovation Models grant and a Medicaid Health Home program.51
Given all these initiatives, the state may be positioning itself to improve on even more indicators in the next Scorecard.
|ACCESS & AFFORDABILITY|
|Adults ages 19–64 uninsured||47|
|Adults who went without care because of cost in the past year||37|
|Individuals with high out-of-pocket medical spending||26|
|Employee health insurance contributions as a share of median income||6|
|PREVENTION & TREATMENT|
|Home health patients who did not get better at walking or moving around||51|
|Nursing home residents with an antipsychotic medication||49|
|Medicare beneficiaries who received a high-risk prescription drug||46|
|Adults with mental illness who did not receive treatment||28|
|Hospital patients discharged without instructions for home recovery||27|
|Adults without all age-appropriate vaccines||7|
|AVOIDABLE HOSPITAL USE & COST|
|30-day hospital readmissions, age 65 and older||23|
|Short-stay nursing home residents with a 30-day readmission to the hospital||20|
|Admissions for ACS conditions, ages 65–74, per 100,000 Medicare beneficiaries||12|
|Admissions for ACS conditions, age 75 and older, per 100,000 Medicare beneficiaries||10|
|Long-stay nursing home residents with a hospital admission||5|
|Colorectal cancer deaths per 100,000 population||39|
|Adults who smoke||32|
|Adults who report fair/poor health||4|
Note: For the purposes of the Scorecard, we count the District of Columbia as a state, and it may be included in tally of number of states that improved.