New York Healthcare Analytics

Healthcare Analytics for New York Hospitals and Clinics

New York spends more than $92 billion annually on Medicaid — the highest per-capita Medicaid expenditure in the country — while simultaneously pushing health systems through a mandatory Value-Based Payment (VBP) transformation that rewards population health outcomes over encounter volume. New York health systems need analytics infrastructure sophisticated enough to navigate Medicaid Global Cap constraints, VBP performance measurement, and the extreme cost structure of operating in one of the world's most expensive labor markets.

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$92B+Annual New York Medicaid spending — highest per capita in the US
New York Healthcare Landscape

New York's Healthcare Data Challenge

New York's 220+ acute care hospitals include some of the most complex and expensive medical institutions in the world. Northwell Health (23 hospitals, the largest health system in New York), NYU Langone, Mount Sinai Health System, NewYork-Presbyterian, and Montefiore Medical Center collectively operate under an extreme cost structure — clinical labor, real estate, and regulatory compliance costs in New York City exceed nearly every other US market. This cost structure exists alongside a massive safety net obligation: New York's public hospital system (NYC Health + Hospitals) is the largest municipal hospital system in the country, and Medicaid covers approximately 7.3 million New Yorkers, nearly 40% of the state's population.

The New York State Department of Health's Value-Based Payment (VBP) roadmap has set aggressive targets for shifting Medicaid payments from fee-for-service to population-based contracts. Systems must demonstrate performance on Total Cost of Care, Clinical Quality, and Utilization metrics that require not just data collection but genuine population health analytics at scale. Meanwhile, the Medicaid Global Cap — New York's mechanism for constraining state Medicaid spending growth — creates recurring fiscal uncertainty that ripples through DSH payments and supplemental payment pools that safety net hospitals depend on for financial survival.

220+
Acute care hospitals across New York
$92B+
Annual NY Medicaid spending
7.3M
NY Medicaid enrollees
40%
NY population covered by Medicaid
How Vizier Helps

New York-Specific Analytics Solutions

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Value-Based Payment Performance
New York's VBP roadmap requires health systems to track Total Cost of Care, utilization, and clinical quality metrics at the attributed population level. Vizier maps your EHR and claims data to NYSDOH VBP measure specifications, identifying high-cost attributed patients and care gaps before performance periods close.
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Safety Net Financial Analytics
New York's safety net hospitals depend on Medicaid DSH payments and supplemental pools that are subject to Global Cap constraints. Vizier models DSH eligibility by payer mix and uncompensated care volume, and tracks supplemental payment triggers in real time to optimize revenue recovery under New York's complex Medicaid supplemental payment architecture.
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Medicaid Managed Care Quality
NY Medicaid Managed Care plans — MetroPlus, Fidelis, EmblemHealth, and others — require contracted hospitals to meet HEDIS quality benchmarks that directly influence capitation rate calculations. Vizier surfaces HEDIS measure gaps at the patient level, enabling proactive outreach before measurement periods end.
New York Health Systems

Organizations Like These Face New York's Analytics Challenges

Health systems like Northwell Health, NYU Langone, Mount Sinai Health System, NewYork-Presbyterian, Montefiore Medical Center, and Albany Medical Center face a market where Empire BlueCross BlueShield, UHC, Aetna, EmblemHealth, and MetroPlus Health Plan each impose distinct quality measurement frameworks. Managing HEDIS performance across commercial, Medicare Advantage, and Medicaid Managed Care contracts simultaneously — in a cost environment where a single FTE analytics hire exceeds $150,000 — demands automation that conventional BI tools cannot provide.

Northwell Health (23 hospitals)
NYU Langone Health
Mount Sinai Health System
NewYork-Presbyterian
Montefiore Medical Center
Albany Medical Center
Regulatory Context

New York Compliance and Reporting Requirements

New York Medicaid managed care is administered through contracts with plans including MetroPlus Health Plan (NYCHHC), Fidelis Care (Centene), EmblemHealth, and WellCare. The NYSDOH requires encounter data submission through the eMedNY system with strict timeliness standards. Incomplete or delayed encounter data affects managed care capitation rates and triggers compliance reviews that can result in financial penalties.

New York's Delivery System Reform Incentive Payment (DSRIP) program, now transitioning into a new Value-Based Payment framework, required performing provider systems (PPSs) to track quality and utilization metrics across attributed Medicaid populations. The successor VBP arrangements embed the same population health analytics requirements into long-term Medicaid contracting. New York also maintains robust SPARCS (Statewide Planning and Research Cooperative System) hospital discharge data reporting requirements that serve as a foundation for public quality reporting and benchmarking.

Medicaid Program
New York Medicaid — 7.3M enrollees (NYSDOH)
Managed Care
MetroPlus, Fidelis/Centene, EmblemHealth, WellCare
Key Reporting
eMedNY encounter data, SPARCS discharge data, VBP quality measures
Get Started in New York

New York healthcare organizations are turning data into better outcomes.

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