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Hometown Health Selects MedHOK’s Integrated Platform to Enhance Care Management, Compliance and Improve Star, HEDIS and Other Risk Scores

Hometown Health Selects MedHOK’s Integrated Platform To Enhance Care Management, Compliance And Improve Star, HEDIS And Other Risk Scores

TAMPA, Fla. – Dec. 19, 2012 – MedHOK, one of the healthcare industry’s fastest growing software companies, announced today that Hometown Health will deploy its single cloud-based platform to proactively comply with federal and state regulations, enhance care management and improve Star, HEDIS® and other quality scores. In doing so, Hometown Health, the insurance division of northern Nevada’s largest integrated health network, is positioned to respond to efforts by the Centers for Medicare & Medicaid Services (CMS) to enhance quality and reduce costs.

Based in Reno, Nev., Hometown Health is northern Nevada’s largest and only locally-owned not-for-profit health insurance company, providing wide-ranging medical coverage that includes Senior Care Plus, the region’s premier Medicare Advantage plan. It is the insurance division of Renown Health, a Top 100 integrated health network comprised of three acute care hospitals, a rehabilitation hospital, skilled nursing facility, the area’s largest medical group and an urgent care network.

MedHOK’s single platform for care, quality and compliance drives improved outcomes and enhanced quality and positions integrated delivery systems for success in an environment where reimbursements are increasingly linked to quality performance. Hometown Health will leverage an array of services delivered across the integrated platform, including medical utilization and care management, appeals and grievances, complaints tracking, hierarchical condition categories (HCC) risk adjustment processing and annual HEDIS and STAR filings. These will enable the health plan to monitor and track quality measures and improve HEDIS and STAR scores on a year-round basis.

MedHOK’s innovative single platform will provide us with the information we need to achieve and maintain compliance with CMS’ stringent quality reporting requirements,” said Linda Ash-Jackson, MD, medical director, Hometown Health. “It will also help us provide better quality care at lower costs and allow us to respond more agilely to the rapid regulatory and reimbursement changes that characterize today’s evolving healthcare landscape.”

MedHOK offers fully NCQA-certified software for HEDIS®, Pay for Performance (P4P) and Disease Management performance measures. Its single platform for care, quality and compliance facilitates improved clinical outcomes and care coordination while enhancing quality measures, regulatory compliance and financial performance. It accomplishes this by:

  • Providing real-time access to Star, HEDIS, P4P and proprietary quality and performance measures, helping plans and providers to accurately monitor in real-time the data they need to achieve and maintain high quality ratings.
  • Triggering interventions when care gaps are identified, in particular for patients with multiple co-morbidities and chronic conditions.
  • Utilizing predictive analytics models to generate profiles based on clinical, quality and financial data for member, provider and local populations.
  • Calculating risk scores for every member, enabling timely predictions of those at the highest risk for more accurate forecasting of care costs and utilization.
  • Continuously monitoring for and addressing regulatory changes from CMS and state Medicaid agencies, ensuring clients stay ahead of the compliance curve.

“The pressure to increase quality and reduce costs has never been greater for integrated delivery systems and health plans alike. They also face greater compliance challenges than ever before as the transformation to a quality- and performance-based healthcare system continues,” said Anil Kottoor, president and CEO, MedHOK. “By utilizing the full array of services provided across our integrated cloud-based platform, Hometown Health will be well-positioned to meet all federal and state mandates and gain a competitive advantage in their marketplace.”

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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