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Upper Peninsula Health Plan Selects MedHOK to Close Care Gaps, Enhance Care Management and Compliance and Improve Quality Scores

Upper Peninsula Health Plan Selects MedHOK To Close Care Gaps, Enhance Care Management And Compliance And Improve Quality Scores

TAMPA, Fla. – March 6, 2012 – MedHOK, one of the healthcare industry’s fastest growing software companies, announced today that the Upper Peninsula Health Plan (UPHP) will deploy its integrated care management, quality and compliance platform to proactively close care gaps, comply with federal and state regulations, enhance care management and improve Star, HEDIS® and other quality scores. In doing so, UPHP is positioned to respond to Centers for Medicare & Medicaid Services (CMS) and Michigan Department of Community Health (MDCH) efforts to enhance quality outcomes and reduce costs. MedHOK, which offers fully NCQA certified software for HEDIS, has more than 15 million live in production and is on track to reach 30 million within the year, making it one of the healthcare industry’s leading software companies.

Based in Marquette, Mich., UPHP serves as the hub for all Medicare, Medicaid and managed care activity in Michigan’s Upper Peninsula. It will leverage MedHOK’s integrated platform to facilitate the real-time exchange of comprehensive clinical information to improve outcomes and quality scores by addressing care gaps and improving utilization, disease, care and quality management for UPHP’s 30,000 covered lives.

“As the industry continues to sharpen its focus on improving care, quality and costs, including efforts to link them to financial incentives, it was clear that moving to an integrated care and quality management environment was essential for UPHP,” said Dennis H. Smith, president and chief executive officer, UPHP. “Because it integrates all of the information we need into a user-friendly, web-based platform, MedHOK software was the logical choice to help us continue delivering high-quality, innovative and cost-effective healthcare services in today’s evolving outcomes-based reimbursement environment.”

MedHOK’s integrated care management, quality and compliance platform facilitates improved clinical outcomes and care coordination while enhancing quality measures, compliance and financial performance. It accomplishes this by:

  • Providing real-time access to Star, HEDIS, pay-for-performance (P4P), and proprietary quality and performance measures, helping providers 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 comorbidities 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

“To succeed in today’s evolving healthcare environment, health plans must deploy technologies that enable continuous monitoring of care and performance measures,” said Anil Kottoor, president and CEO, MedHOK. “MedHOK’s integrated care management, quality and compliance platform provides the real-time data and web-based tools necessary to not only track key metrics, but also identify and eliminate care gaps before they can impact quality scores.”

About MedHOK

Tampa, Fla.-based MedHOK has more than 15 million lives in production and expects to double that number in 2012, making it one of the healthcare industry’s fastest growing software companies. It offers a cloud-based integrated software platform for care management, quality and compliance that enables physicians, ACOs, PCMHs, payers and TPAs to manage and measure care against national quality standards for optimal outcomes. Its innovative modular software helps healthcare organizations meet quality, care and compliance objectives across business lines by facilitating real-time information sharing with all stakeholders to address disease management and care coordination, clinical quality and utilization review, and quality and financial measures. ICD-10 compliant, HIE-ready and securely accessible on any device, the MedHOK platform is user-friendly, rapidly deployed and easily configurable for a low total cost of ownership and rapid return on investment. The company’s 360Measures holds full 2012 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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