METROPLUSHEALTH ACHIEVES MAJOR QUALITY MILESTONES ACROSS MEDICARE, MEDICAID, AND SPECIALIZED CARE PROGRAMS

From a 4-Star Medicare rating to New York State’s number one-ranked HIV Special Needs Plan, MetroPlusHealth continues to deliver outstanding outcomes for New Yorkers

NEW YORK, NY (TIP):  MetroPlusHealth, New York City’s high-quality, affordable health plan, today announced a series of major quality achievements across its Medicare, Medicaid, HIV Special Needs Plan (HIV SNP), and Health and Recovery Plan (HARP) programs, underscoring its commitment to delivering high-quality, equitable care for New Yorkers. Together, these accomplishments highlight MetroPlusHealth’s continued success in improving member health outcomes, enhancing the member experience, and advancing health equity through its integrated partnership with NYC Health + Hospitals.

“These remarkable achievements reflect the extraordinary dedication of our teams, providers, and community partners who work every day to help New Yorkers live healthier lives,” said Dr. Talya Schwartz, President and Chief Executive Officer of MetroPlusHealth. “Whether serving older adults, individuals living with HIV, members with behavioral health needs, or families enrolled in Medicaid and the Essential Plan, our mission remains the same: to deliver high-quality, member-centered care that helps our communities thrive.”

Delivering Results Across the Organization

• Medicare: For the second consecutive year, MetroPlusHealth earned an overall 4-Star Medicare Rating from the Centers for Medicare & Medicaid Services, including 4 Stars for Part C and 4.5 Stars for Part D prescription drug coverage. The rating reflects strong performance across 45 measures evaluating clinical quality, member experience, pharmacy services, and operations.

• HIV Special Needs Plan: MetroPlusHealth ranked number one among New York State HIV Special Needs Plans for the fourth consecutive year in the HIV SNP Quality Incentive Program. The plan earned the highest overall score among participating plans, achieving a quality score of 91.76 and a total score of 80.4. It also earned all 45 points available for viral load suppression—the program’s most heavily weighted measure and a critical indicator of effective HIV treatment and long-term health outcomes for people living with HIV. This achievement reinforces MetroPlusHealth’s longstanding leadership in HIV care and its commitment to connecting members with specialized care management, community outreach, and treatment services.

• Medicaid: MetroPlusHealth achieved Tier 1, the highest performance tier available, in New York’s Medicaid Quality Incentive Award program for Measurement Year 2024. The plan earned credit on 32 of 36 quality measures, achieving 90th-percentile performance on 11 measures spanning preventive care, behavioral health, maternal health, and chronic disease management. These results reflect broad-based improvements in delivering high-quality care for MetroPlusHealth’s Medicaid and Child Health Plus members.

• Health and Recovery Plan (HARP): MetroPlusHealth earned back 100% of the available quality withhold under New York’s Health and Recovery Plan quality program for Measurement Year 2024, following similarly strong performance in Measurement Year 2023. This accomplishment reflects the program’s success in supporting members with significant behavioral health needs, integrating physical, mental health, and substance use services, and highlights MetroPlusHealth’s care management, care coordination, and member support.

Together, these outcomes demonstrate MetroPlusHealth’s ability to deliver exceptional results across multiple lines of business while serving one of the nation’s most diverse member populations. Through ongoing partnerships with NYC Health + Hospitals and community provider partners, MetroPlusHealth continues to improve member outcomes, strengthen the member experience, advance health equity, and create value for the communities it serves.

“Quality is at the center of everything we do,” said Dr. Schwartz. “These achievements show what’s possible when we invest in coordinated, equitable, and evidence-based care. Most importantly, they represent better health, better experiences, and better outcomes for the members and communities we serve.”

For more information, please visit metroplus.org