By Jon Phillips, Director, Health Information Technology

After much planning, design, build and validation, Millennium’s population health management platform will be deployed this month, starting with chronic disease and wellness registries and reporting out of the enterprise data warehouse.

The initial deployment will feature the use of both ambulatory electronic medical record system (EMR) and Medicaid claims data from ECMC, Kaleida Health and Niagara Falls.

The remaining early adopters will start by using their Medicaid claims data until their Continuity of Care Documents (CCDs) are made available to HealtheIntent once they are sent to HEALTHeLINK  , our Regional Health Information Organization (RHIO).

This launches an exciting new age of population health management in Western New York. Our claims and electronic medical record data will be used to develop actionable insights for our PPS providers to improve the quality of care while reducing unnecessary hospital admissions and emergency room visits. This will happen in multiple ways.

  1. From our Medicaid claims data, we will be able to use advanced analytical tools to identify Medicaid members who are most likely to be high utilizers of health services, including hospital admissions and ER visits. Our PPS providers can use this information to develop focused interventions to better manage identified chronic conditions and improve wellness.
  2. HealtheIntent now offers 40 different patient registries. From the available patient data, the registries will be used to identify care gaps based on evidence based best practices. This will help care teams to effectively and efficiently deliver care to improve patient health.
  3. Based on performance in closing care gaps, physicians and their care teams will be able to review their performance in scorecards to identify areas of clinical practice they have particular strengths in, and other areas that represent opportunities for improvement.
  4. Our Enterprise Data Warehouse will provide the most complete patient information in Western New York. We call it the “patient 360.”   We can use the available standard reports and create our own ad hoc reports to identify opportunities for improving population health. With this information, care design teams can develop and enhance interventions to improve patient health and reduce unnecessary cost.

It should be noted that Millennium’s population health management platform has met the very strict security and privacy requirements of the State of New York Department of Health. The confidentiality of patient information is our highest priority.





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The Erie County Medical Center Corporation (ECMCC) is the parent organization of Millennium Collaborative Care

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