Data Sources

Our Health Care Report Card uses data from many sources, and combines them into one format that we hope makes this data more user-friendly. Some data is collected or obtained from external sources, these are described below.

HMO Data

Medical Reports

The HMO medical data we use comes from two sources: HMO data reports and consumer opinion surveys. The performance data contained within the 2024 Report was reported in 2005 and is the most recent data available.

HMOs collect and report data on a set of standard measures. HEDIS® is a nationally recognized measurement set that serves as a standard measuring tool to compare HMOs. All the clinical measures used in this report card come from HEDIS, so that an HMO's performance in New York or New Jersey can be compared to other HMOs, both within the state and nationally.

Consumer Opinion

HMOs in New York and New Jersey survey their members on satisfaction with the HMO. The questions used in the survey were derived from the CAHPS 3.0H survey, which is part of the HEDIS measurement set. The HMOs contract with independent survey firms to conduct the surveys.

We obtained New York HMO HEDIS data from the New York State Department of Health's Office of Managed Care. New Jeresy HMO HEDIS data was obtained from the New Jersey Department of Banking and Insurance.

HMO Pricing

HMOs report the monthly premium they would charge a retail customer for a standard plan that includes basic services, and do not reflect discounts available for group purchasing. Rates change often, and you should always call the HMO for an up-to-date price.

We obtained New Jersey HMO pricing data from the State of New Jersey Department of Banking and Insurance, the New York pricing data was obtained from the New York State Insurance Department.

Hospital Data

Medical Reports

The appropriate care data presented in our report card comes from New York State hospitals that volunteered to submit their data for public reporting. The clinical measures reported here focus on heart attack, heart failure, pneumonia and surgical infection prevention. Each rate calculation reported is based upon the hospital's relevant discharges.

We obtain this data from the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services. We then report the data provided, and calculate the composite scores.

The data available to us at time of publication included reports up until September of 2024. In this report, a hospital year begins in October and ends in September.

Administrative Data

The information we present on hospital stays is derived from New York State's Department of Health Statewide Planning and Research Cooperative System (SPARCS), and the State of New Jersey Department of Health and Senior Services uniform billing data files (UB-92 inpatient).

The data used in our Health Care Report Card comes from de-identified versions of this data. No patient-specific data is known to us at any time.

We sort this data using a variety of tools, including the Agency for Healthcare Research and Quality's Inpatient Quality Indicators.

Patient Safety

Our patient safety data is derived from the most recent data available from the Leapfrog Group, for more information visit http://www.leapfroggroup.org

HEDIS® is a registered trademark of the National Committee for Quality Assurance.