Success Story

HHPWNY Partners Align for Successful Care Management

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Read about how HHPWNY achieved a 181% increase in primary care utilization and 32% decrease in ED usage

Health Home Partners of Western New York (HHPWNY), located in Buffalo, is a Medicaid Health Home partnership that brings together a wide range of care services across the region to deliver comprehensive medical, behavioral, and social service care to the population. To achieve these results, HHPWNY leveraged:

  • Collaboration on a uniform standard of care enables all downstream providers to support the care plan
  • Interoperability with EHRs and other tools used by the partners integrates a wide range of diverse data into a single care plan that can be accessed by all partners
  • Custom assessments track specific information to identify key patient issues
  • Timely alerts enable followup after critical events, including ED visits, according to policy guidelines
  • Real-time updates in the field enable the care team to go where the patients are
  • Analysis across disparate business entities provides insight into how to close care gaps, strategically identify at-risk patients, and allocate resources where they make the most impact

Using GSI Health’s population health management platform as an enabling technology, HHPWNY successfully achieved an 181% increase in primary care utilization and 32% decrease in emergency department (ED) usage, verified via a recent NY state Medicaid Health Home redesignation audit.