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MedHOK Software Helps Drive Successful Provider, Payer Participation in CMS Comprehensive Primary Care Initiative

MedHOK Software Helps Drive Successful Provider, Payer Participation In CMS Comprehensive Primary Care Initiative

TAMPA, Fla. – Oct. 20, 2011 – MedHOK announced today that its integrated suite of cloud-based quality, care management and compliance software for the healthcare industry helps meet the needs of those seeking to participate in the Centers for Medicare & Medicaid Services’ (CMS) Comprehensive Primary Care (CPC) initiative.

The CPC initiative is a Center for Medicare and Medicaid Innovation (CMMI) pilot program that seeks to improve outcomes and reduce costs by emphasizing the role of primary care and care management in the health system. The initiative will pay primary care case management risk-adjusted fees that initially average about $20 per member, per month to primary care practices participating in traditional Medicare. Practices that also serve Medicaid beneficiaries may be eligible for additional payments to augment care for those individuals.

CMMI is also seeking to partner with insurers and plans in all lines of business to enhance primary care and care management in similar ways.

“MedHOK’s software can play a vital role in helping participating practices meet the various goals and objectives laid out by CMS for the CPC initiative,” said Anil Kottoor, president and CEO, MedHOK. “Our innovative technology identifies those in need of chronic care management and preventative care, and aids primary care physicians in appropriate follow up and case management.”

A major component of the CPC initiative is the ability to share information across a patient’s continuum of care. MedHOK has created a health information exchange where primary care physicians, specialists and other providers are linked up to coordinate care by viewing and acting upon comprehensive clinical data for each patient in real time.

MedHOK provides web-based software that is easily implemented and is the perfect solution for real-time information sharing among providers in the CPC initiative. Especially key for participating primary care physicians operating in a Medicare fee-for-service environment will be MedHOK software’s ability to receive enrollment, eligibility and demographic data on assigned beneficiaries. Also, the software allows physicians to receive claims and other data from Medicare and other providers, ensuring they have access to as comprehensive a clinical history as possible for each patient.

MedHOK software also provides the following features that support the CPC initiative:

  • A leading predictive modeling and stratification tool to identify high-risk or multiple co-morbid cases in need of intervention. Based on hundreds of elements, the software stratifies patients in numerous areas, which can act as triggers for care/case, disease and quality management interventions.
  • A fully certified NCQA HEDIS module that identifies HEDIS®, Star and other care gaps. Patients with multiple care gaps can be triggered for care/case, disease and quality interventions.
  • Proactive identification of those in need of preventative care and chronic care management
  • Comprehensive case and disease management modules where assessments can be conducted, care plans created and care plan tasks and interventions (both clinical and social) fulfilled and monitored through a case management tool
  • Comprehensive medication reconciliation and drug monitoring capabilities
  • Easy integration with provider and member portals to ensure the right information is available to all involved in the care of a member

MedHOK software also includes comprehensive fulfillment and correspondence, audit, provider portal, real-time dashboard and reporting functionality.

“The initiative’s main goals are to improve care and quality and reduce costs. MedHOK was developed to do precisely that by creating an environment where the right information is shared with the right people to facilitate the right kind of care,” said Kottoor.

About MedHOK

Based in Tampa, Fla., MedHOK (www.medhok.com) offers cloud-based software solutions that eliminate silos and organize client-specific patient/member data into relevant and actionable information that enables physicians, ACOs, PCMHs, payers and TPAs to manage and measure care against national quality standards for optimal outcomes. Information can be shared in real time with all healthcare stakeholders. MedHOK solutions address disease management and care coordination, clinical quality and utilization review, and quality and financial measures. ICD-10 compliant and HIE-ready, MedHOK solutions are web-based, rapidly deployed and securely accessible on any device. The company’s 360Measures holds full 2011 HEDIS® certification.

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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