Posted on: June 28, 2024

With New York State’s Medicaid 1115 waiver approved earlier this year, the healthcare community from Buffalo to Albany and Plattsburgh to eastern Long Island is striving to help Medicaid recipients achieve their full health potential by focusing on three imperatives:

  • Improving health equity through assessment, identification and treatment of underlying health-related social needs (HRSN)
  • Developing social care networks to coordinate care for HRSN between providers and community-based organizations (CBOs)
  • Addressing the impact of substance use disorder (SUD) on our communities by reducing overdoses and overdose-related deaths

Yet, there is another equally important—though less talked about—component that has future implications upon the delivery of healthcare in New York: the All-Payer Health Equity Approaches and Development (AHEAD) model. In parallel with the waiver, this model will be implemented in select counties and over the next 11 years, AHEAD will seek to transform the way healthcare is delivered in those counties by implementing a collaborative approach to quality, cost analysis and restructuring.

The model’s success will, in brief terms, be defined by cost savings; a “win” judged by the overall success of the community. Global budgeting will be introduced at participating hospitals, requiring them to manage and care for a specific patient population to reach defined outcomes. To succeed in this model, hospitals and primary care practices must work together in coordination with health plans to reduce unnecessary inpatient and ED use that result from uncoordinated care and unmet HRSN among patients covered by Medicaid.

Community-wide insights drawn from aggregated clinical, claims and HRSN data will be a critical component to achieving success in this model. Organizations focused on value-based care—such as accountable care organizations (ACO)—have shown a universal dashboard accessible to providers of all types, that is independent of health plans, can drive clearer and actionable decisions. An approach like this is necessary to identify opportunities, improve communication between providers and patients and achieve optimal outcomes.

Does this sound familiar? If you follow our work, it should. Hixny is already working with payers, government and providers—from traditional primary care to specialty practices, Federally Qualified Health Centers to urban hospitals and outpatient networks, and, increasingly, first responders, CBOs providing social care, and mental and behavioral health providers. We are experts in bringing the data from these providers together to assist in improving care by providing a single consolidated view of the patient population they serve.

Hixny is the ideal solution to support the waiver-related efforts, and advances under the AHEAD model. We’re already integrating the data in one place—and we have a 25-year history of collaboration and trust with partners and users across the breadth of the health care landscape.

We expect there will be much discussion about the type of technology and information exchange that’s needed to support the AHEAD model in the years to come. We stand ready and able to hit the ground running as soon as the communities begin to tackle this difficult transformation. We look forward to helping the community get a “win” and seeing patients achieve their full health potential.

Hixny will be performing extended maintenance beginning Thursday, December 31 through Friday, January 1. During this time, all services
will be impacted and unavailable—including access to the provider portal.