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How to survive and improve in New York: Importance of being well rated in the MLTC performance data

Updated: Jun 30, 2020

During the last 15 years, MLTC programs have increased their number of members all over the state of New York. The number of MLTC enrolees nearly tripled in the period 2010-2012, and it keeps growing. With these results, MLTC programs represent opportunities for new plans to enter the New York market.

When we analyze the data carefully, we find that the growth rate has been decreasing at a rapid pace since 2012. The enrolment growth rate for all plans in New York was high in 2012 because of the implementation of new laws in the state related to Healthcare, but it has been decreasing since.

The number of plans entering the MLTC market was almost 42% more between 2014 and 2015 than in previous years. During this time there were 74 plans, but in the latests measurement period there are only 57 plans participating in MLTC programs.

The variation on the number of plans responds to a tough market in New York. In general, around 30 plans have remained in the MLTC programs since 2014. The other plans either merge with other companies, they do not participate in this program anymore or simply closed doors.

New York is a tough market and acquiring new members is vital for plans. The competition is fierce, and surviving for a long time seems very complicated.

MLTC star-rating seems a perfect place where potential new clients can go and research information about MLTC. It is a semi-annual evaluation of the plans by New York state and all the information is public. The state condensates all the information it collects (different type of measures, survey-based or population-based measures across all plans in the MLTC program) the results are reported by the end of each semester, and there is a process where, depending on the results of these measures, a final rating is assigned to each plan (1 to 5 stars).

These results and ratings are vital for plans since all of them are evaluated on the quality of care they provide and on enrolees’ satisfaction [1].

Getting good results and being rated with the highest possible number of stars is an opportunity to improve the enrolment of plans.

MLTC: measures, domains, and stars

New York state qualifies a lot of measures, but not all of them are included in the MLTC star-rating of plans. The information considered by the state are the following: 18 measures grouped in 12 domains, these domains grouped in 4 quality areas.

Sample of measures, domains and quality areas the state of New York considers to rate plans.

Initially the state performs measurements across all plans in the MLTC program, collects the data and reports the results of these measures. For example, in the case of Influenza Vaccination measure, corresponds to the percentage of members who received an influenza vaccination in the last year or the measure Rating of Health Plan is the risk-adjusted percentage of members who rated their managed long-term care plan as good or excellent.