February 01, 2010 | Palo Alto, California: As the US health care system undergoes reform, several health insurance and healthcare providers are stepping up their Governance, Risk and Compliance (GRC) programs by implementing MetricStream to manage their risk management programs, streamline internal audits and ensure compliance with multiple regulatory requirements and corporate policies. Several healthcare providers and health plans, including some of the largest licensees and affiliates of the Blue Cross and Blue Shield (BCBS) Association, recently selected MetricStream to response to rapidly changing regulatory and market requirements.
The MetricStream Enterprise GRC Platform and solution suite delivers a powerful combination of process automation, best-practices workflows, data integration, reporting, analytics and regulatory content. Organizations can quickly address immediate business issues, such as streamlining Medicare RAC Audit or NAIC MAR Compliance program, extending their use of MetricStream over time to create an integrated and enterprise-wide architecture for GRC that includes:
- CMS Medicare and Medicaid Compliance
- Compliance with State Regulations
- Regulatory Content and Alerts Tracking
- OIG Corporate Integrity Agreements (CIA)
- OIG Work Plan
- Market Conduct Examinations
- NAIC Model Audit Rule
- Medicare RAC Audits
- Conflict of Interest Surveys
- Code of Conduct Management
- Corporate and Legal Policy Management
- Enterprise and Operational Risk
- Risk and Control Self-assessments
- SOX Compliance and Financial Controls
- Internal Audit
- HITECH, HIPAA, Identity Theft Regulations
- IT Controls and Risk Management
- Reportable Events and Investigations
- Adverse Incidents and Case Management
- Quality Accreditations (NCQA and URAC)
With increasing pressure from government for healthcare providers and health insurers, a sound GRC technology architecture is a critical component for sustaining compliance, preventing fraud and managing a wide array of risks. As the business complexity and focus on accountability increases, risk and compliance executives are seeking better visibility and quick access to information which is difficult to collect, monitor and communicate.
MetricStream solutions feature role-based views that offer insights into core GRC processes and key metrics. Real-time dashboards and reports help customers track the status and trends relating to key risk and compliance programs. The applications are designed to help businesses rapidly identify risks in their operations, helping minimize exposures through monitoring of incidents and compliance activity and effective audit management. When risks or exceptions are identified, users have the information they need to drive the necessary action items and remediation plans through automated workflows.
Give the highly regulated nature of the industry, easy access and efficient management of laws, regulations, standards and guidelines as well as translation of this information into actionable tasks is pivotal. MetricStream’s integration and interfaces with proprietary content repositories and external information and content services creates a unique environment which ensures responsiveness to changes in the market.
MetricStream has emerged as the preferred GRC vendor in recent competitive evaluations by several healthcare and health insurance companies based on its ease-of-use, configurability, scalability and security. The applications provide powerful workflow and collaboration features to implement well defined semantics for GRC elements such as policies, risk, control, control objective and risk mitigation and applying them across various processes to create a consistent risk and compliance culture and approach. Powerful reporting and dashboarding further differentiates MetricStream as it helps provide clear answers to executives on questions such as “how well are we assuring or mitigating a specific risk?” and “how much assurance work has been done on a particular regulation or control?” on risk heat maps, compliance dashboards and KRI charts.
"The US health care system is adapting to a new regulatory regime and operating environment. The transition will drive crucial changes in how companies adopt and implement GRC and the underlying IT infrastructure," said Gaurav Kapoor, CFO and General Management at MetricStream. "We're responding to this shift by offering best-in-class solutions that help healthcare and health insurance companies in becoming more efficient and more transparent, allowing them to improve performance, control costs and deliver better health care outcomes.”