New York Uses AHRQ Prevention Quality Indicators to Support Medicaid Reform Legislation

May 2009

As a result of attending an AHRQ-sponsored Medicaid Medical Directors Learning Network workshop, New York State Medicaid officials used AHRQ's Prevention Quality Indicators (PQIs) to map geographic regions in need of improvement in the delivery of ambulatory care for asthma and diabetes patients. The findings were important in supporting a Medicaid reform package in the State legislature.

James J. Figge, MD, MBA, Medical Director, Office of Health Insurance Programs, New York State Department of Health, learned about the PQI metrics at the Learning Network workshop held in November 2006 as part of AHRQ's Knowledge Transfer Program.

State employees participating in the workshop reviewed claims data related to several common chronic diseases affecting the Medicaid population. They unearthed numerous quality issues affecting the delivery of care for diabetes and asthma. Building on what he learned through participation in the Learning Network, Figge and his staff calculated the asthma and diabetes PQI scores for every ZIP code in New York State.

Figge says, "The PQIs have basically allowed us to define the fact that there are serious issues with the delivery of ambulatory care as exemplified by those two chronic diseases. This allowed us to come up with a legislative reform package that has given us a number of new tools to address those concerns."

AHRQ's PQIs are screening tools that use hospital discharge data to identify conditions affected by the quality of care outside the hospital—ambulatory care-sensitive conditions—among adults. The PQIs assess the quality of care for 14 conditions, including rates of hospital admissions for asthma and diabetes. Despite being among the top three states in total per-capita health care spending, New York ranks 39th among states for hospital admissions for preventable conditions.

The PQIs were a cornerstone of the data package presented to the New York State legislature, resulting in substantial Medicaid reform in the 2008-09 budget. Not only did the PQI scores identify which chronic conditions could be prevented; they also helped pinpoint which regions of the State were most in need of an intervention.

Notes Figge, "New York State is definitely making major use of AHRQ's tools to change the State's health care system. The State is using the tools to move resources from the inpatient setting to the ambulatory care setting in an effort to improve the quality of ambulatory care."

Several new interventions for the geographic areas identified by the PQIs are now in operation as a result of this legislative reform. For the first time, Medicaid is paying certified diabetes educators and certified asthma educators to work in clinics and physicians' offices to provide self-management education. The educators work with patients to assess the medical, economic, and social issues presenting barriers to receiving quality medical management and improving the control of their disease.

A medication therapy management program was also approved by the legislature. A pilot program targeting asthma was implemented in retail pharmacies in the Bronx, where Medicaid claims data is used to identify patients in need of additional intervention. The patients are invited by the pharmacist to participate in the program. The pharmacists provide one-on-one, individualized counseling about patients' diseases and their medication therapy. This program reinforces the education patients receive from the certified asthma educators at their physicians' offices and other clinics.

As Medicaid implements these strategies, Figge notes, the PQI tools will be very important as a standardized measure to document the outcomes of the interventions.

The maps showing the PQI scores for each New York State ZIP code is publicly available on the New York State Department of Health Web site at:

The Web tool encourages health planners, advocates, and the public to use the PQI data to identify gaps in needed services in their communities and to strengthen local health care planning.

Medicaid in New York State has a projected budget of $45.6 billion for the 2008-09 fiscal year. The program serves just over four million beneficiaries, with approximately 79 percent being in a managed care program.

Impact Case Study Identifier: 
AHRQ Product(s): HCUP-Prevention Quality Indicators, Healthcare Cost and Utilization Project (HCUP), Medicaid Medical Directors Learning Network
Topics(s): Asthma, Policy, Chronic Care: Breathing Conditions
Geographic Location: New York
Implementer: New York State Department of Health
Date: 05/01/2009
Page last reviewed October 2014