Managed Care Data Sharing Collaborative
MILLENNIUM COLLABORATIVE CARE ("MCC")
- Presentation is also available in Portable Document Format (PDF)
NYS ALL PPS WEBINAR – 12/8/2017
Vital Statistics: 260,000 Medicaid Recipients Attributed to Millennium
- 3.4% of New York State Medicaid Recipients are attributed to Millennium
- 26% of WNY residents are Medicaid recipients 52% of Medicaid recipients in WNY are attributed to Millennium
- 14% of the entire population of WNY is attributed to Millennium
The Millennium Mission
We are a Population Health Services Organization for our partners within the MCC network.
Beyond the services we provide, our true purpose and passion is improving health care quality, access & outcomes through a best–in–class physician–driven & analytics enabled transformation.
Our goal is to provide population health management programs and services to some 250,000 attributed Medicaid members across the eight counties of Western New York.
|top of page|OUR JOURNEY
MCC Provider Needs Assessment
- According to the NYS 2014 Managed Care Survey in WNY:
- 81.6% of Medicaid MCO Expenditures were governed by FFS arrangements
- 17.8% were governed by VBP Level 0 Arrangements
- Of 73 provider partners that were surveyed by MCC:
- Only 1 provider was receiving extensive clinical information from the MCOs
- The majority of our provider partners received:
- No data at all – 41%
- Basic data – 26%
- Limited or selective data –16%
- Few partners had a 360–degree comprehensive view of the patients they were attempting to manage.
MCC – Our Partners and VBP
- The introduction of Value Based Payment into this market has resulted in a flurry of recent discussions and activities around the formation of IPAs and ACOs:
- There is an increasing demand for the tools and analytics that will be needed by these organizations to support VBP contracts and ensure optimal population health management.
- Millennium is committed to supporting a regional population health management strategy in this region and has invested in the Cerner HealtheIntent population health management platform.
98% of our network partners have expressed a willingness to use a population health management tool provided by MCC.
|top of page|CHASING THE DATA
- Millennium has developed a multi–tiered strategy to collect and populate CERNER HealtheIntent with data. Our partners include:
- WNY RHIO – HealtheLink
- EMR and Clinical Data Feeds from Hospital Partners
- FQHCs
- Managed Care Organizations
MCO DATA SHARING AGREEMENTS
MCC and MCO Collaborative
- Identify "win–win" opportunities and partner on targeted performance improvement initiatives that benefit both organizations.
- Create data sharing agreements and exchanges that promote optimization of the management of the Medicaid population.
- Create an inventory of programs and incentives for both the providers and members. Identify opportunities to promote and/or collaborate in a manner that maximizes desired outcomes. Avoid duplicative programs.
- Support the introduction and adoption of value based payment arrangements within the community.
Data Sharing Contract – Structure
- Zero Cost Management Services Agreement:
- Contract is between MCC and IHA for population health management services.
- MCC has contracted with Cerner for the population management health platform.
- Data will be sent directly from IHA to Cerner.
- Initially the data will be limited to Medicaid patients attributed to MCC as defined by the NYS MCC Patient Roster.
Scope of Work
- Accept and stage data for reporting and analysis in Cerner´s HealtheIntent population health management platform using Independent Health enrollment, medical and pharmacy claims for attributed Medicaid members.
- Generate performance reports on mutually agreeable key performance indicators for a physician´s members, as attributed by Independent Health.
- Populate patient chronic disease and wellness registries with IHA data to assist physicians and practices with the identification of gaps in care, targeting members for outreach and performing pre–visit planning.
- Provide a care management tool to enable care and transition planning across care settings.
- Provide leading practice guidelines and support for Care Coordinators at Millennium´s contracted medical and behavioral health providers to achieve our mutual targeted performance objectives.
- In collaboration with Independent Health, provide analytic services to identify opportunities for improvement on targeted high value performance metrics.
- Educate and mobilize medical and behavioral health providers to develop and implement plans for quality improvement.
- Collaborate with community–based organizations to identify and address social determinants that are barriers to engagement in care.
Compliance and Risk Assessment
- The submission of a very detailed Vendor Risk Assessment that outlined MCC and Cerner policies, controls, security protocols, workflows and system requirements/specifications relating to data exchange was required.
- This assessment has been reviewed and approved by the IHA legal, risk and compliance teams pending receipt of additional MCC desktop security policies and controls.
- Once these documents are received and approved, IHA is poised to deliver a contract template to our legal team.
Business Continuity Controls
- Business Continuity Plans:
- How often do updates occur?
- How are emerging threats and vulnerabilities incorporated into the Plan?
- Recovery Plans:
- Primary and Secondary sites
- Disaster Recovery testing
- Invoking Business Continuity Plan
- Documentation of Previous Business Interruptions / Outages –
- Cause, remediation and recovery timeframes.
- Regulatory Agency Issues or obstacles impacting recovery efforts
- Strategies/Plans for the following:
- Loss of work space
- Personnel shortages or unavailability
- Degradation of service
- Data center outages o Application Outages o Cyber Attacks
- Operations at Recovery Site
- Server Capacity
Compliance Controls
- Compliance Officer
- Internal Department dedicated to corporate compliance and healthcare regulatory compliance
- Compliance risk assessments related to regulatory compliance
- Notification of changes in ownership or criminal convictions by managing employees
Offshore Oversight
- Details of all contractual/sub–contractual arrangements
- Assessment and Evaluation of alternatives
- Type and amount of PHI associated with the arrangement
- Regulatory Requirements incorporated into the agreements Policies and Procedures
- Training
- Auditing
Vendor Oversight
- Delegation and sub–contracting controls
- Oversight functions – auditing, compliance
- Deficiency Remediation
- Training Requirements and oversight
- Policies and Procedures –Record Retention
- Compliance Training – including Fraud, Waste and Abuse
- Type of Training
- Frequency of Training
- New Hires
- Specialized Training
- Exclusion and Sanctioned List Checks (OIG, LEIE, GSA, EPLS, OMIG, OFAC) including frequency
In the Interim
- The MCOs have provided MCC with aggregate information and current trends for:
- PCP Access
- Non–utilizers
- Avoidable admissions and readmissions
- Preventable ED visits
- Medication Adherence Measures
- The MCO is sending a list of patients who are non–compliant with targeted DSRIP P4P measures directly to the providers.
- MCC is deploying resources to review this data and work with the practice to develop work flows and a plan of action to manage these patients and improve performance.
- The MCOs are actively working on solutions to address billing and claims issues that MCC has identified as barriers to improving the performance metrics and meeting NYS DSRIP targets.
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