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APS Healthcare and Thomson Reuters to Manage New York State’s Medicaid Clinical Best Practices Review Program


Health Analytics and Utilization Review Services to Improve Safety and Quality of Care

Ann Arbor, MI — APS Healthcare, a leading provider of specialty healthcare solutions, and Thomson Reuters, a global business information company, have been selected by the New York State Department of Health to manage the state’s Medicaid clinical best practice utilization review program.

The program examines how Medicaid patients utilize 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 behavior 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 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, Office of Health Insurance Programs (OHIP).

Under the contract, 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 NY Medicaid recipients,” said Michael H. Rosenberg, MD, president, Medical Society of the State of New York.

“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.”

APS, which operates 41 Medicaid programs in 26 states and Puerto Rico, focuses on improving overall health and wellness through education and interventions that promote behavior change, improve health outcomes and reduce long-term healthcare costs. Thomson Reuters’ Advantage Suite® is currently used for data analytics and decision support by Medicaid and other government agencies in 28 states.
Thomson Reuters will deploy its Medstat Advantage Suite® solution, which combines a customized repository of healthcare data with a comprehensive set of analytic tools. The system generates intelligence and benchmarks that governmental agencies use to analyze and manage the cost and quality of healthcare delivered to their beneficiaries.

“We’re proud to partner with APS Healthcare to serve the State of New York, using Advantage Suite’s advanced methodologies and business intelligence applications to power APS’ innovative and data-driven interventions,” said Jon Newpol, executive vice president of the Thomson Reuters Healthcare and Science business. “We are confident our services will benefit the state, its healthcare practitioners and ultimately, its Medicaid members.”

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.

About Thomson Reuters
The Healthcare business of Thomson Reuters produces insights, information, benchmarks and analysis that enable organizations to manage costs, improve performance and enhance the quality of healthcare. Thomson Reuters is the world’s leading source of intelligent information for businesses and professionals. We combine industry expertise with innovative technology to deliver critical information to leading decision makers in the financial, legal, tax and accounting, scientific, healthcare and media markets, powered by the world’s most trusted news organization. With headquarters in New York and major operations in London and Eagan, Minnesota, Thomson Reuters employs more than 50,000 people in 93 countries. For more information, go to


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