News

KEPRO Appoints Susan T. Weaver as President

HARRISBURG, PA – KEPRO, a leading medical management and cost containment solution provider for government and private sector clients in the health care sector, announced today that Susan T. Weaver, MD, FACP, has joined the company as President.

As President of KEPRO, Dr. Weaver will be responsible for driving new products and services into the commercial payer space in addition to serving as the lead operating executive, ultimately responsible for deploying corporate strategy and achieving expected results.

“I am extremely pleased that Susan is joining our executive leadership team to lead and cultivate KEPRO’s approach to medical management and solution delivery,” said KEPRO CEO Joseph A. Dougher. “Susan’s extensive clinical expertise and business acumen will further KEPRO’s goal in developing strategic and comprehensive solutions that will make a difference in the lives of those we serve.”

Dr. Weaver most recently served as Chief Executive Officer for C3HealthcareRx, an innovative company providing in-home medication management and personalized pharmacy services. In her time as CEO the company doubled in size with the addition of two pharmacies and the expansion of licensing to 13 states. In addition, Dr. Weaver reorganized operations to deliver outcomes for a large national health plan and system to create a scalable, replicable model.

Before her time at C3HealthcareRx, Dr. Weaver served as the Chief Medical Officer for Blue Cross Blue Shield of North Carolina, the state’s largest insurer, where she led the company’s Health Delivery Redesign and Network Management divisions as well as Medical Policy, Medical expense strategy, disease management and wellness programs, network quality and performance, quality improvement accreditation, and appeals and grievances.

Dr. Weaver previously held various executive positions at WakeMed Health & Hospitals, including serving as the organization’s Executive Vice President of Medical Affairs and Physician Practices. She is also a founding member and former Executive Director of Alliance Medical Ministry, a not-for-profit organization providing a medical home to the working uninsured of Wake County, NC.

“With KEPRO’s recent acquisition of Health Information Designs and moving into the Pharmacy Utilization field, Susan’s experience and clinical knowledge will be paramount in the development and delivery of our holistic care management model and solutions,” stated Dougher. “Her expertise and experience will be a cornerstone in the future growth of our company.”

Dr. Weaver received her B.S. in Psychology from Duke University, and her M.D. from Duke University School of Medicine. She completed her residency at Massachusetts General Hospital in Boston, Massachusetts and is board-certified in Internal Medicine and a fellow of the American College of Physicians.

To learn more about the services and solutions KEPRO offers, visit www.kepro.com.

You can also get health tips, information about our organization or learn about exciting job opportunities by following us on Twitter, on  Facebook or on LinkedIn.

Media Contact: Jamie Kopko, Director of Corporate Communications, JKopko@Kepro.com, 717.564.8288 x7076

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KEPRO Acquires Health Information Designs

Acquisition enhances KEPRO’s suite of solutions and services in the pharmacy management arena

Harrisburg, PA – KEPRO announced today that it has acquired Health Information Designs (HID), a leading vendor of pharmacy administrative services in the U.S.  

Founded in 1976, HID assists health care organizations to improve patient health while reducing costs through HID’s combination of clinical, professional and informational technology expertise in health care analytics and pharmacy support services.

“HID has a long history of successfully designing, implementing and operating sophisticated systems to support their public and commercial clients,” said KEPRO CEO Joseph A. Dougher. “Their portfolio of products and services in pharmacy management will enable KEPRO to offer further customization capabilities providing our clients the opportunity to design a suite of services specific to their needs and requirements for efficient and cost-effective care management.”

HID’s solutions strategically increase a plan’s control of the coverage determination process while ensuring therapy appropriateness. HID deepens the strength of coverage programs by maximizing efficiency, auditability, consistency and reducing administrative burdens. Improved health outcomes are delivered through HID’s expanded criteria sets, lower approval rates, improved data access, proven CMS compliance, and decreased ingredient cost.

KEPRO COO Meghan Harris said, “HID’s experience and reputation as a national leader in analytics and pharmacy management builds upon KEPRO’s suite of solutions to provide a comprehensive service list to deliver on their promise to transform the medical management arena through innovative, flexible and cost-effective offerings.”

HID currently provides clinical services to 39 clients in 31 states across the nation, serving more than 18 million covered lives. HID’s systems and services include the following areas: eClinical Solutions, Decision Support Systems, Prescription Drug Monitoring Solutions, Drug Utilization Review Solutions, Prior Authorization, and Preferred Drug List Solutions.

HID CEO Rob DiBenedetto stated, “Our goal at HID is to improve outcomes and reduce utilization costs for our clients. Through our partnership with KEPRO we have an opportunity to deliver a whole new, integrated approach to care management that allows our clients to select from a suite of services that run the gamut from physical, behavioral and now pharmacy care management.”

KEPRO, the nation’s largest CMS-designated quality improvement and care management organization, offers innovative and outcomes-focused solutions to reduce the utilization of health care resources and optimize the quality of care for public and commercial clients. Headquartered in Harrisburg, Pennsylvania, KEPRO has 15 offices nationwide and serves more than 20 million members.

To learn more about the services and solutions KEPRO offers, visit www.kepro.com.

Media Contact: Jamie Kopko, Director of Corporate Communications, JKopko@Kepro.com, 717.564.8288 x7076

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KEPRO to Manage TennCare’s Children’s Health Insurance Program and Processing Center

HARRISBURG, PA – KEPRO announced today that TennCare, the state of Tennessee’s Medicaid program, has awarded the Children’s Health Insurance Program, CoverKids, and TennCare’s Application Processing Center contract to KEPRO.

With the new contract, KEPRO will assist the state in the handling of applications, referrals and overall management of the administration and processing required for both programs via an Application Processing Center.

“KEPRO’s growth to provide eligibility services and application processing is an exciting next step for our relationship with TennCare and Tennesseans,” said KEPRO CEO Joseph A. Dougher. “We look forward to providing cost-effective and efficient management, including exemplary customer service to TennCare and CoverKids members.”

The processing center will augment the TennCare and CoverKids call center by handling applications and redetermination information via phone, mail, fax and referral, entering information and completing all state approved eligibility determination application processing tasks. 

For more than a decade, KEPRO has supported the TennCare program through medical necessity, clinical contraindication and hardship reviews, providing medical testimony at fair hearings, in addition to various quality improvement initiatives through audits and analytical analysis. KEPRO also provides training on medical and eligibility appeals processing, as well as onsite IT support. 

In September 2017, KEPRO also began managing TennCare’s toll-free call center assisting members with filing medical issues or appeals by phone.

To learn more about the services and solutions KEPRO offers, visit www.kepro.com.

You can also get health tips, information about our organization or learn about exciting job opportunities by following us on Twitter, on  Facebook or on LinkedIn.

Media Contact: Jamie Kopko, Director of Corporate Communications, JKopko@Kepro.com, 717.564.8288 x7076

About TennCare

TennCare is the state of Tennessee’s Medicaid program which provides health insurance to approximately 1.4 million low-income Tennesseans including pregnant women, children, caretaker relatives of dependent children and older adults and adults with physical disabilities.  With a satisfaction rating above 90 percent since 2009 TennCare provides health insurance through the use of managed care.   

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Please describe KEPRO data security that ensures member information is protected.

As an organization that is charged with storing and transferring Protected Health Information (PHI), KEPRO is bound by HIPAA regulations, and is accustomed to managing the security and privacy of PHI. KEPRO currently exchanges data successfully and confidentially via secure encrypted means in support of all of our federal, state, and local government programs, and with commercial clients.

KEPRO has been implementing and supporting systems that require medical record, data security, and transmission for more than a quarter of a century, and has always placed primary importance on using systems that allow for fast and efficient connectivity, while still providing the highest level of data and system security. Our proven internal and external policies and protocols ensure compliance with state and federal laws and regulations, as well as any additional security measures you may require.

We have a stringent KEPRO Comprehensive Confidentiality Plan that governs our processes. KEPRO’s Privacy Officer, Security Officer, and the Compliance Officer have ultimate responsibility for oversight of the processes and procedures contained in the KEPRO Comprehensive Confidentiality Plan.

KEPRO's system is secure. Our information systems are secured by an in-depth strategy that utilizes multiple layers of operational, management, and technical controls to protect KEPRO assets. We also employ software programs designed to prevent unauthorized use by staff or outside entities.

All KEPRO information systems employ common security controls such as Firewalls, Anti-virus, Role Based Access, FIPS 140-2 Encryption for mobile devices, and the requirement of strong passwords. Information system users are assigned a security role based upon access requirements relevant to their positions and information/program privileges.

The HIPAA Security Rule requires entities to implement information systems that control access to healthcare and related systems. KEPRO adopts a subset of NIST 800-53 Rev 3 Security controls to maintain compliance with HIPAA. Based on these security standards, KEPRO mitigates risk to its Information system by focusing on such controls as:

  • Log-In Security. HIPAA security requires the use of secure User IDs and the use of passwords. KEPRO requires multiple account authentication processes within its information systems to verify the identities of our end-users. KEPRO's policy requires strong passwords that are changed frequently.
  • Access Control. HIPAA requires one of the following: Context Based Access, Role Based Access, or User Based Access. User Based Access is part of the Log-In Security component. KEPRO's Role Based Access gives individual users access relevant to their function in the organization.
  • Audit Trail. HIPAA requires the use of an audit trail to identify who accesses PHI. KEPRO systems track those who change the patient record, the date and time the record was modified, and the specific information changed. The system includes a read only audit trail that captures each time a system user views a case.
  • Session Time-out. KEPRO information systems account for session inactivity by locking screens after 10 minutes of inactivity.
  • KEPRO's physical space is secure. KEPRO’s computer, telephone, and hardware systems are located in climate controlled rooms with fire-suppression and electronic locking system. We allow only authorized access to the room.
  • KEPRO focuses training on confidentiality and security issues. All KEPRO employees undergo rigorous training on security and confidentiality of PHI. We have successfully provided this training to all staff regardless of their respective roles/duties.

KEPRO Headquarters

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777 East Park Drive, Harrisburg, PA 17111
Toll-free: 800.222.0771
Phone: 717.564.8288
Fax: 717.564.3862