TAMPA, FL – MedHOK, which develops cloud-based care management and compliance software, has partnered with New York County Health Services Review Organization (NYCHSRO)/MedReview to help health plans drive improvements in their HEDIS scores.
Developed by the National Committee for Quality Assurance (NCQA), the Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of U.S. health plans to measure performance on important dimensions of care and service.
The new partnership will utilize MedHOK’s 360Measures, which is NCQA-certified for HEDIS, to provide health plans with data aggregation and real-time information tracking and performance monitoring to identify and address gaps in care before they can impact quality and HEDIS scores.
[See also: NCQA launches new online tool to reduce health disparities.]
Additionally, NYCHSRO/MedReview, a leader in healthcare-related quality and utilization review services for more than 37 years, will provide comprehensive chart reviews. These play an essential role in boosting scores on HEDIS hybrid measures by identifying clinical information not available in claims data.
“NYCHSRO/MedReview is pleased to have the opportunity to form a strategic alliance with MedHOK,” said Joseph Stamm, CEO, NYCHSRO/MedReview. “MedHOK’s cutting edge technology combined with our experienced and seasoned Quality Review Services will create the superior HEDIS analytical product on the market today. We become the one-stop shop for health plans, eliminating the need to hire multiple vendors to track HEDIS data and perform chart reviews.”
[See also: Personalization key to payer communication.]
“Through the innovative combination of MedHOK’s HEDIS-certified software and MedReview’s experienced nursing staff, this alliance will provide health plans with the most comprehensive set of resources available on the market today for monitoring and tracking quality to improve performance and prevent the year-end surprises that plague many payers,” said Anil Kottoor, president and CEO of MedHOK.
Officials say the alliance offers payers an end-to-end solution that improves management of the HEDIS process. This includes:
- Proactive identification of HEDIS care gaps, which enables clients to notify members and providers of the need to obtain necessary services through multiple pathways and avoid year-end surprises
- NCQA-certified software for the production of administrative data
- Production of samples for hybrid measures
- Expert hybrid chart review, including tracking, project management and integration with administrative data
- Consulting services to help analyze and define HEDIS improvement targets for all lines of business
- Real-time target setting and tracking of HEDIS measures for ongoing progress monitoring and performance evaluation
Founded in 1974, NYCHSRO was one of the first organizations registered as a certified Utilization Review (UR) agent in New York. With a diverse client base that includes state and local government entities, managed care organizations, health insurers and third-party payers, NYCHSRO has conducted more than 2 million peer reviews to evaluate clinical decisions and services rendered by medical practitioners.
MedReview is a subsidiary of NYCHSRO, which was established as one of the first physician peer review organizations in the United States. The organization provides clients with guaranteed cost-effective case management and utilization analysis approaches that can assist them in developing or negotiating more cost-efficient benefit plan strategies.
