August 06, 2009 ikaEnterprise Goes Live at New York City’s Touchstone Health

New Technology Solution Paradigm Allows Medicare Advantage Health Plan to Quickly Cut Administrative Costs in Half

Touchstone Health, a Medicare Advantage health plan committed to making quality healthcare simple and readily accessible to its New York Medicare members, has gone live with ikaEnterprise from ikaSystems. ikaEnterprise is a comprehensive suite of Web-based solutions that automate all key processes in the payer business cycle — from marketing and sales through claims administration and customer service to care and quality management — all on a single integrated technology platform. For Touchstone Health, ikaEnterprise will deliver the level of enterprise-level data sharing that the company needs to improve the member experience and drive performance improvement in both revenue management and medical expense management.

According to Michael A. Muchnicki, Touchstone Health’s president and chief executive officer, ikaSystems was the right partner to help Touchstone fulfill its mission to enhance the delivery of high-quality, cost-effective and proactive healthcare services for its members.

“Our organization was founded in 1998 by physicians who were entirely committed to creating a healthcare experience that is more compassionate, simple and useful for older New Yorkers, which demands better orchestration of care between providers, members and families,” Muchnicki explained. “ikaEnterprise enables us to not only function highly efficiently from an administrative point of view but also better understand and more effectively act upon gaps in care. For Touchstone Health, the technology provides an ideal foundation for the planned growth of our business.”

Muchnicki cited modularity, a high degree of configurability and easy integration with third-party solution providers as key elements in Touchstone Health’s decision to implement ikaEnterprise. In addition, the quality of ikaSystems’ staff was instrumental to the project’s success. “The ikaSystems team has been knowledgeable, responsive and dedicated to significantly lessen the burden of extensive conversion from a very dated and manual system. Given the large scope of this project, our implementation timeframe was incredibly short, and we have immediately created significant efficiencies with the new platform, leading to reductions in our operating expenses,” said Muchnicki.

“Our work with Touchstone Health has been extremely rewarding in that we’ve been able to see such rapid before-and-after results,” said Ravi Ika, chief executive officer of ikaSystems. “In today’s challenging marketplace, ikaSystems’ technology is an absolutely essential component of any health plan’s growth strategy because it addresses the significant opportunities that remain in the typical plan to more effectively manage administrative expenses while stabilizing medical expenses.”

Touchstone Health serves 15,000 members in 11 counties, with a concentration in the boroughs of New York City. The company has gone live with the following components of ikaEnterprise:

• ikaClaims, a flexible, efficient claims administration and customer service system that quickly delivers high auto-adjudication rates. All system components and business rules can be user-defined, from the most basic to the most specific level of detail. Health plans can take advantage of pre-loaded benefit categories and fee schedules as well as standard/system codes to effortlessly incorporate custom benefit plans and respond quickly to changing market demands. ikaClaims accepts and produces all HIPAA-compliant transaction code sets (834, 270, 271, 278, 837, 276, 277, 835, 820) and allows plans to set rule- and role-based security levels. Greater payment efficiency and transparency made possible by Web-based access and integration also significantly improve provider relations and the impact of collaborative care management programs.
• ikaCRM, which automates and combines sales processes for both individual and group Medicare with a complete array of marketing functions, including prospect, lead, campaign, literature and event management. Payers can easily evaluate the effectiveness of marketing campaigns, electronically route work to more productive resources, receive alerts about delinquent leads and perform a host of other useful functions. The results are highly efficient work processes, reduced workloads and processing time, and most importantly increased throughput — essential during the crush of enrollment periods.
• ikaCallCenter, comprehensive and highly customizable customer service automation to track every interaction with members, providers and brokers. Health plans can configure category and sub-categories of call types, pre-formatted documentation comments and work queues for review of inquiries to other departments or individuals. Customer service representatives have inquiry-only access to benefits, provider file, and claims data, and group level data as well as update access capability to certain demographic fields of the member file. Streamlined workflows and full reporting capabilities improve efficiency, accountability and customer satisfaction.

Implementation of the remaining components of the ikaEnterprise product suite is targeted for completion later in August. Additional components include:

• ikaMedicareGateway, which automates Medicare enrollment and membership/payment reconciliation processes to dramatically reduce administrative costs, increase compliance conformance and achieve higher levels of member satisfaction through more streamlined process management
• ikaBilling, a highly configurable premium billing solution that allows health plans to set their own rules for late payments and benefit revocation, and members and others to make payments online.
• Member Portal, which supports administrative self-service as well as medical management self-care tools. For example, members can verify eligibility verification, order ID cards, check claims status, collaborate with the care team and keep personal health records.
• Provider Portal, which reduces providers’ administrative burden by automating processes such as eligibility verification, claims submission, authorization and referral submission and approval. In addition, the Provider Portal gives physicians proactive access to quality information so they can improve HEDIS measures and pay-for-performance results.

About Touchstone Health
Touchstone Health, headquartered in New York City, is a Medicare Advantage health plan focused on the Medicare market. Touchstone Health currently has approximately 15,000 Medicare beneficiaries in Bronx, New York, Kings, Queens, Richmond, Orange, Westchester, Broome, Chenango, Delaware and Onondaga counties. Benefits are available to anyone enrolled in both Medicare Part A and B and continue to pay their Medicare applicable premiums. Touchstone Health is a privately held company owned and advised by, among other investors, Essex Woodlands Health Ventures, Southern Cross Capital, and Stephen Wiggins. The company was founded in 1998 by a group of neighborhood physicians to bring personalized health care to New York. Touchstone Health prides itself on its local focus and customer service. For more information about Touchstone Health, please visit the company’s website at www.touchstone-health.com.

About ikaSystems Corp.
ikaSystems is healthcare payers’ premier provider of enterprise-level Web-based technologies for commercial, Medicare and Medicaid lines of business. ikaEnterprise, the company’s flagship product, automates all key processes in the payer business cycle — from marketing and sales through claims administration and customer service to care and quality management — all on a single integrated platform. Using our agile, modular technology, organizations can proactively move to lower administrative and medical care expenses and thrive in even the most challenging environments. To learn more, please visit www.ikasystems.com.