Program Information
The inter-organizational Data Analytics and Quality Improvement teams support both AHI and the Adirondacks ACO through:
Program Evaluation
Supporting health outcome data collection and evaluation for grants and community-based partners.
Data Management
Collecting, validating, and using data consistently and reliably.
Interactive Reporting
Developing and sharing interactive reports through the AHI Reporting Portal.
Population Health Analytics
Supporting AHI grants and programs’ data collection and reporting requirements.
Financial Reporting
Supporting leadership through generation of financial snapshots and trends.
Quality Measurement
Supporting quality measure abstraction, analysis, and reporting, as well as measurement related to quality improvement activities.
Opportunity Identification
Monitoring performance trends and patterns in data sources to identify quality and performance improvement opportunities for our stakeholders.
Education and Knowledge Sharing
Hosting workgroups and collaboratives where best practices, resources, and knowledge can be shared to advance the quality care in the region.
Maximize Accuracy of Reporting and Measurement
Evaluating and monitoring for areas of inaccuracy which could lead to inadequate capture of the efforts of our stakeholders.
Program Evaluation
Supporting health outcome data collection and evaluation for grants and community-based partners.
Data Management
Collecting, validating, and using data consistently and reliably.
Interactive Reporting
Developing and sharing interactive reports through the AHI Reporting Portal.
Population Health Analytics
Supporting AHI grants and programs’ data collection and reporting requirements.
Financial Reporting
Supporting leadership through generation of financial snapshots and trends.
Quality Measurement
Supporting quality measure abstraction, analysis, and reporting, as well as measurement related to quality improvement activities.
Opportunity Identification
Monitoring performance trends and patterns in data sources to identify quality and performance improvement opportunities for our stakeholders.
Education and Knowledge Sharing
Hosting workgroups and collaboratives where best practices, resources, and knowledge can be shared to advance the quality care in the region.
Maximize Accuracy of Reporting and Measurement
Evaluating and monitoring for areas of inaccuracy which could lead to inadequate capture of the efforts of our stakeholders.
What does an Accountable Care Organization (ACO) do?
The Adirondacks ACO works with 16 healthcare entities throughout the region to provide the highest quality care to their patients. We work to improve quality and reduce costs by focusing on utilizing data analytics to help our stakeholders identify the opportunities and act on them. By assisting our partners in improving their quality performance and decreasing the use of expensive health care we are able to bring back “shared savings” from our various arrangements with public and commercial payor partners.
More information about the Adirondacks ACO can be found here:
Vision
Stakeholders using data to improve community/population health.
Mission
To generate, analyze, engage, educate, and innovate data to support AHI and the Adirondacks ACO’s stakeholders in improving health-related services and meeting their business needs.
The Strategic Pillars
Program Details
The inter-organizational Data Analytics and Quality Improvement teams support both AHI and the Adirondacks ACO through:
GRANT-FUNDED PROGRAMS
The Data Analytics and Quality Improvement teams support grant-specific data collection and management, evaluation strategy, data analysis, and grant reporting activities for AHI, the Adirondacks ACO, and their partners.
• AHI-led Grants
The Data Analytics team currently supports data collection, evaluation, and outcome reporting for AHI-led grants, such as the HRSA Chronic Disease Care Coordination Network (CDCCN) grant, the HRSA Workforce grant, and the Mother Cabrini Health Foundation Workforce grant.
• Partner-led Grants
The Data Analytics team currently supports data collection, evaluation, outcome reporting, and data visualizations for the North Country Heart Network’s HRSA “Get Healthy North Country!” network development grant.
• ACO-led Projects
The Data Analytics and Quality Improvement teams provide facilitation and reporting support for Fidelis’ Health Plan Community Support.
NON-GRANT FUNDED PROGRAMS
The Data Analytics and Quality Improvement teams support data collection, management, and reporting for several of AHI’s regional population health programs.
- Community Health Assessment (CHA)
The Data Analytics team is working with AHI and its regional CHA partners to create an interactive dashboard for easier synthesis of the region’s health and health-related characteristics and needs in order to support our CHA partner’s generation of their Community Health Improvement Plans. - AHI Lead Health Home
The Data Analytics and Quality Improvement teams provide technical support related to billing, data management, and data visualizations, as well as supports quality performance monitoring related to the Health Home’s payer contracts. - The Adirondacks ACO
The Data Analytics and Quality Improvement teams support the Adirondacks ACO through data management, quality measurement, and performance monitoring.
This includes:
- The Client Data Warehouse (CDW) – The CDW is a secure data repository supported through collaborative partnerships between AHI, the Adirondacks ACO, Hixny (the regional health information exchange), the ACO’s contracted health plans, and the ACO’s participating provider organizations. It contains both claims and clinical information for the ACO’s attributed members and allows for more robust reporting that supports both the ACO’s provider organizations and their regional partners.
ACO DATA REPORTING
- The AHI Reporting Portal
- (Health Plan) Gaps in Care
- Pre-visit Planning
- Daily Emergency Department and Inpatient Visits
- Attribution Report
- Quality, Utilization, and Integrated Care (QUIC) dashboard
Other Reporting
- Financial performance summary reporting.
- Quality and Process Improvement Activities.
- Monitoring performance opportunities and strengths to share with stakeholders as a group or individually.
- Monitoring and educating on changes in quality measures.
- Providing manual and automated reporting support.
- Fostering accountability through citizenship criteria that includes a set of requirements structured to accomplish the mission and vision while bringing additional financial support back to our stakeholders.
- Providing opportunities for organization-level process improvement support.
Interested in Working With Us?
The Data Analytics and Quality Improvement teams are eager to support any current and future partners with their data and/or quality needs.
Program Timeline
Data and quality projects are continuous and year-round – Generally tracking and trending reports are refreshed regularly based on the availability of updated underlying data and the end users’ needs. Meanwhile performance reports, such as the annual ACO quality results and State and Federal grant outcomes, are tied to performance year reporting.
Resources & FAQ
Current partners and stakeholders can click here to access the AHI Reporting Portal.
Case Study
In 2023, the Data Analytics team completed the development of an Adirondacks ACO-specific Diabetes Dashboard to better facilitate the monitoring of key performance indicators including those that have not had as much focus previously. The dashboard also allows for monitoring of emergency department and inpatient utilization in the Diabetes, Prediabetes, and Non-diabetes populations. The new dashboard better enables us to identify areas where the ACO can focus its efforts.
The ACO’s efforts have made a significant difference in regional health, as seen below. These results have consistently placed the Adirondacks ACO well above the 90th percentile for both QARR and HEDIS benchmarks.
Team Members & Contacts
Please contact Laura Morris if your organization is interested in receiving data and/or quality support services from our teams.
Laura Morris
Director of Data Analytics and Information Technology
Email: lmorris@ahihealth.org
Phone: 518.480.0111 x.330
