Specialty healthcare solutions provider APS Healthcare and business information company Thomson Reuters, US, have been selected by the New York State Department of Health to manage the state's Medicaid clinical best practice utilisation review programme.
The programme examines how Medicaid patients utilise medical services and explores patterns of potentially unnecessary care and opportunities for improving patient safety or quality of care. The results of sophisticated analytics will be provided to physicians and clinics to enhance the opportunity to improve clinical outcomes through increased knowledge of patients' adherence to treatment or, in some cases, patients overuse of treatment services.
The project leverages the clinical and behaviour change expertise of APS Healthcare and the unique analytic and predictive modeling capabilities of the Medstat Advantage Suite application from Thomson Reuters to identify patient safety issues and flag healthcare services that are duplicative or outside evidenced-based practice guidelines. It will give New York State practitioners prioritised, actionable information they can use to improve health outcomes for Medicaid members.
Under the agreement, 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.
Thomson Reuters will deploy its Medstat Advantage Suite solution, which combines a customised repository of healthcare data with a comprehensive set of analytic tools. The system generates intelligence and benchmarks that governmental agencies use to analyse and manage the cost and quality of healthcare delivered to their beneficiaries.
The project, scheduled to start by early summer 2009, will review the healthcare services delivered to 3 million New York fee-for-service Medicaid recipients.
