The New York State Department of Health will use services from APS Healthcare and Thomson Reuters for its Medicaid clinical best practice utilization review program.
The program examines how Medicaid patients use medical services and explores patterns of potentially unnecessary care and opportunities for improving patient safety or quality of care.
The project, scheduled to start this summer, will review the healthcare services delivered to 3 million New York fee-for-service Medicaid recipients.
The project leverages clinical and behavior change software from White Plains, N.Y.-based APS Healthcare and analytic and predictive modeling services of Thomson Reuter's Medstat Advantage Suite application to identify patient safety issues and flag healthcare services that are duplicative or outside evidenced-based practice guidelines. Medstat Advantage Suite combines a customized repository of healthcare data with a comprehensive set of analytic tools, generating intelligence and benchmarks to analyze and manage the cost and quality of healthcare delivered to beneficiaries.
"Combining APS' clinical and analytical expertise with Thomson Reuters's advanced business intelligence and clinical support tool will improve the quality of care that New York Medicaid members receive," said Jerry Vaccaro, MD, president and chief operating officer of APS Healthcare. "Through this data-driven and evidence-based approach, we can also help the state make better use of their healthcare resources and lessen the burden of Medicaid spending on the state budget."
Officials say the project will give New York practitioners prioritized, actionable information they can use to improve health outcomes for Medicaid members.
"This program will help us ensure that services delivered to Medicaid members are medically appropriate, effective and efficient," said James Figge, MD, medical director of the Office of Health Insurance Programs.
APS will be responsible for reviewing fee-for-service Medicaid claims to identify practice patterns that may not conform to physician-developed evidence-based standards, provide information about documented best practices that improve outcomes (e.g., dilated eye exams for diabetic patients) and involve clinician peers who will collaborate with the provider community before, during and after implementation of this initiative.
"Collaboration is critical and can be optimized through regular communication and education of physicians through clinical peers. We support this initiative because it will enhance the quality of care delivered to N.Y. Medicaid recipients," said Michael H. Rosenberg, MD, president of the Medical Society of the State of New York.
