S.3146 / A.6021 – Quality incentive program for managed care

This legislation, S.3146/A.6021, would establish the Medicaid managed care quality incentive (QI) program in statute, with funding subject to appropriation.  QI program measures and funding are a critical tool used by plans to advance improvements in the quality of care provided to Medicaid members, and the New York Health Plan Association (HPA) strongly supports this legislation.

New York has been a national leader in delivering high-quality care to its Medicaid beneficiaries – largely as a result of efforts by managed care plans and their provider and community partners.  The QI program has been an essential resource in advancing quality in Medicaid, helping to incentivize efforts aimed at addressing the core causes of health disparities and improving health outcomes for underserved populations.  Further, it has been vital in moving the health care delivery system toward effective, value-based care by enabling health plans to partner with providers on efforts to improve outcomes in primary and pediatric care, integrate medical and behavioral health care, and address social care needs.

Health plans are measured on outcomes intended to address disparities faced by the most vulnerable Medicaid members.  Measures can include whether pregnant individuals receive timely pre- and post-natal care, whether children and adults receive appropriate preventive care and screenings, and whether home-bound members receive care to keep them out of the hospital.  Health plans only receive incentive funding for achieving superior results, and QI funds are used to support programs include:

• Covering the cost of healthy food home delivery programs to members with chronic illnesses and high-risk pregnant individuals.
• Providing in-home wellness visits for individuals who have not recently utilized the health system connect them to preventive care and other vital services.
• Investments to test innovative care models, like using maternal care navigators and doulas to improve care coordination and follow-up for high-risk pregnant individuals.

The Department of Health’s own 2020-2021 report on the Medicaid Quality Incentive Program recognized the important work this funding supports, stating:

“The use of financial incentives has proven successful in engaging Medicaid managed care plans in developing infrastructure, programs, and resources to promote high quality care.  Incorporating financial incentives that tie payment directly to quality is an important approach to improving the quality of care, holds health plans accountable for the care they provide, and rewards those who invest in processes that improve care.”

Nevertheless, funding for this program has been consistently reduced over the past several years and the FY24 Executive Budget eliminates it altogether.  It is imperative that the QI program be adequately and consistently funded to incentivize continued progress on improving equity, eliminating disparities and ongoing health care reform and redesign overall.  This legislation takes an important step of protecting the QI program and initiatives it supports by codifying it into statute.

HPA appreciates the Legislature’s recognition of the importance of the QI program as a way to invest in high-quality and high-value care, reflected in this legislation.

For all these reasons, HPA supports S.3146/A.6021.