Managed Care Data Sharing Collaborative


  • Presentation is also available in Portable Document Format (PDF)


Vital Statistics: 260,000 Medicaid Recipients Attributed to Millennium

Graph of Potentially Preventable Readmission
  • 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
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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.

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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.
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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.
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98% of our network partners have expressed a willingness to use a population health management tool provided by MCC.

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  • 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
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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.
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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.
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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.
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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.
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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
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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
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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
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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
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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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Thank you – questions?

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