Health Information Exchange Featured Article

March 05, 2012

MedHOK Enhances Quality Improvement Initiatives for Simply Healthcare

MedHOK recently announced that Simple Healthcare, a Florida-based HMO, has deployed its MedHOK platform for optimizing its quality improvement initiatives. By deploying this innovative and integrated care management platform, Simply Healthcare has enhanced its capability to improve quality outcomes and bring down costs for Centers for Medicare & Medicaid Services (CMS) and the Florida Agency for Health Care Administration (AHCA).

MedHOK’s fully NCQA certified software for HEDIS which has 15 million and more live in production with a projected reach of 30 million this year, will consolidate the company’s position among the leading providers of software solutions for the healthcare industry.

In a release, Dwight Pattison, director of quality management, Simply Healthcare, said, "We appreciate the expertise MedHOK brings to the table and their collaborative approach to achieving our goals.”

A Coral Gables, Fla.-based HMO, Simply Healthcare, serves residents of Florida’s Medicaid and Healthy Kids and Medicare Advantage members. The company will utilize the MedHOK platform at the annual HEDIS filings in addition to using its unique capabilities to both track down and remediate care gaps resulting in improved outcomes.

MedHOK developed its integrated care management, quality, and compliance platform to optimize clinical outcomes and to improve care coordination. The platform additionally, ensures compliance and improves both quality and financial performance. Users of the MedHOK platform are provided with real-time access to Star, HEDIS, pay-for-performance (P4P), as well as quality and performance metrics which allows for a more accurate and real-time monitoring of data to ensure high quality ratings at all times.

The platform also triggers interventions for patients diagnosed with multiple comorbidities and chronic conditions as soon as care gaps are identified. It also makes use of predictive analytics models to create profiles for member, provider, and local populations that are based on clinical, quality and financial information.  

Additionally, the platform assess and calculates risk scores for every member which ensures that timely predictions are available for high risk patients which in turn allows for accurate care costs and utilization forecasts. The platform also monitors and acts upon regulatory changes from CMS and state Medicaid agencies, which ensures complete compliance for clients at all times.

Anil Kottoor, president and CEO, MedHOK, said, "To thrive into today's healthcare environment, health plans must be committed to improving quality and reducing costs. By leveraging the power of our integrated care, quality, and compliance platform, they can eliminate the year-end HEDIS fire drills through continuous performance monitoring and streamlined workflows that mitigate care gaps."

Edited by Rich Steeves
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