MLTC & Healthcare: Star-Rating for MLTC plans
Updated: Jun 30, 2020
What is The Managed Long-Term Care (MLTC) performance data?
It is a semi-annual evaluation of New York state- certified MLTC plans. Rates are calculated for each performance measure by the plan, and describe their population or assess their quality of care.
Plans are evaluated on the quality of care they provide and on enrollees’ satisfaction [1].
Type of performance data.
Different type of measures, survey-based measures or population-based measures across all plans in MLTC.
The results are reported per semester (in this case 2018), and there is a process where, depending on the results of these measures, a final grade is assigned to each plan (stars).
Areas, Domains and Measures.
There are a total of 18 measures, grouped in 12 domains, distributed in 4 areas. Here we present a sample of measures grouped by Domains and Areas. We can notice that different domains can contain a single measure or more.
The process for Star rating per plan
The star-rating process consists of 7 steps. The first 3 steps are related to the measures, this means we only do some calculation on the result of the single measures.
The last 4 steps are carried out at the domain level. This means that if a domain only has one measure we keep the result of the first 3 steps. On the other hand, if the domain contains 2 or more measures after step number 3, we will average over the total number of measures in the domain.
Example
We will work with the area Stability or Improvement, this area contains 4 domains: ADL Stable or Improved, Pain Intensity Stable or Improved, Shortness of Breath Stable or Improved and Urinary Continence Stable or Improved.
In this specific case, all the domains have only one measure. For simplicity, we will use the domain Urinary Continence Stable or Improved to exemplify the calculation process.
Standardization of measures
Here it is important the distinction between the two types of data. When the measure we are working with is population-based measure, we need to use Nelson's H-statistics to make the calculations. When the measure is a survey-based measure we use Student's t-statistic.