Quality is Essential for All Health Plans

By Errol Pierre, DBA, Healthfirst Senior Vice President, State Programs

Every New Yorker deserves access to high-quality healthcare that offers both dignity and respect. It’s a goal we strive to achieve every day we come to work at Healthfirst.

But it’s an unfortunate reality that how much money someone makes and even the zip code where they live can have an outsized impact on their ability to access care. Coverage rates still differ based on income level. For instance, the highest rates of uninsured New Yorkers occurred in households with incomes between $25,000 and $49,000 in 2021.

That’s why the New York State Essential Plans are a critical part of the mission to lower the rate of uninsured and level the healthcare access playing field for all New Yorkers.

The Essential Plans offered through New York State of Health (NYSOH), the state-run health coverage marketplace, created as part of the Affordable Care Act, provide coverage for people who are not eligible for Medicaid but also are not eligible for coverage from an employer or other source. Before Essential Plans were introduced in 2015, this population would have been paying lots of money out of pocket for coverage or just remain uninsured all together. The plans offer comprehensive coverage with $0 monthly premiums and low-cost sharing.

It’s also vital that those who receive care through Essential Plans have access to the same level of high-quality care as anyone else in New York. That’s why we’re proud that we achieved the No. 1 overall quality ranking from the New York State Department of Health, awarded this year for our 2022 Essential Plan Quality Incentive Program results.

The ranking includes care quality measures from Healthcare Effectiveness Data and Information (HEDIS), results from member satisfaction surveys via Consumer Assessment of Healthcare Providers & Systems (CAHPS), and other metrics including a plan’s submission of a screening tool and intervention report for social determinants of health. Healthfirst’s Essential Plan achieved the highest score among New York State’s 12 Essential Plan products offered.

We aim to have plans for all New Yorkers that need one. So we’re thrilled about the eligibility expansion for Essential Plans that went into effect on April 1 of this year. Now, people who earn up to 250% of the federal poverty level($36,450 annual salary for a single individual) — approximately 100,000 New Yorkers — are eligible for Essential Plan coverage.

Offering high-quality plans is not enough — we must work to get eligible community members enrolled and keep them supported and engaged throughout their healthcare journeys. Our sales and customer service representatives play a significant role in this. They provide culturally competent, hands-on support and speak the languages of the diverse communities we serve, because they live in those communities too.

Ranking as number one among all New York State health plans is a testament to our mission of ensuring all New Yorkers have access to the best healthcare available and can thrive, and lead healthy, fulfilling lives. Isn’t that what every New Yorker deserves?