NYS Health Home Program

Can real-time data improve health and social care outcomes?

I recently read an article that featured the Health Home Program. The discussion primarily addressed issues related to data transparency and inadequate funding.

Care Coordination Wheel

I've had the privilege of working in the Health Home arena since its inception, and I continue to collaborate with Health Homes and Care Management Agencies as a Healthcare Consultant. Over the past few years, Health Homes have led the way in utilizing their members' data to enhance care coordination. By analyzing real-time data, they've demonstrated the benefits of efficient and proactive care management. However, despite this progress, challenges remain in obtaining comprehensive data from the State. This gap emphasizes the importance of real-time data from Health Homes and Care Management Agencies. Such data provides a more immediate view of member needs and serves as a valuable resource for achieving broader healthcare and social care goals. Health Homes play a vital role in driving innovation and advocating for changes to bridge data-sharing gaps.

The following are several domains in which I observe ongoing progress and results; however, continuous push is necessary.

Driving Change and Sustaining Advocacy Efforts

Strengthening Internal Data Operation:

• Invest in advanced analytics tools and staff training to further optimize the use of real-time data.

• Develop quality improvement tools to address barriers that hinder the timely documentation of member engagement.

  
  

Advocate for Improved Data Sharing:

• Collaborate with industry peers to present a unified voice when requesting timely and comprehensive data.

  
  

There is Value in Storytelling:

• Document and publish case studies that showcase how the utilization of real-time data has improved member outcomes and operational efficiency.

• Share these success stories with stakeholders, including State agencies, to advocate for policy adjustments.

  
  

Collaborations with Community Partners:

• Building alliances with other community-based organizations and healthcare providers to share best practices in data analysis and care coordination.

• Assessing outcomes to create evidence-based recommendations for expanding successful strategies.

• Collaborate with advocacy groups and social care organizations to launch innovative, data-driven care coordination initiatives.

I'm always inspired by the Health Homes, Care Management Agencies, providers, members, their caregivers, and families who continue to come together to share their stories and speak out about the incredible benefits of the NYS Health Home program.