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Care Management Solution

Solution Overview

The MedHOK Unified Payer Platform includes a fully integrated Care Management solution that encompasses both case management and disease management functionalities. The component includes numerous auto-generated workflows based on industry best practices that are launched based on answers to assessments with problems, goals, interventions, and care plans. It includes comprehensive workflows with unlimited queues and project management to assign tasks to fulfill and monitor care planning. MedHOK enables offline assessments in conjunction with Model of Care, Long-Term Care, Care Gaps and our integrated 360Member functionality.

CM Offline Functionality

Provides users with the ability to perform the following functions while offline:

  • Access new unassigned and user assigned tasks, referrals and care plans
  • Message to online users when a case is checked out to an offline View Member blue banner bar
  • Document notes at referral or care plan level
  • Add participants to the care team
  • Add, save and / or complete one or more assessments
  • Generate POC from Completed Assessments – when system is synced online
  • Add content to the following Utilities tabs:
    • Conditions
    • Allergies
    • Self-reported medications
    • Vital signs
    • Schedule a follow up task

Transition of Care Program

The MedHOK Unified Payer Platform includes a fully integrated Care Management solution that encompasses Transitions of Care functionalities. Transition of Care is the movement of a patient from one care setting (hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another. MedHOK enables the case manager or designee to provide assistance with care transitions through outreach, follow up and ensuring follow up services, such as a follow up with the Specialist or Primary Care Provider. Transition of Care functionality allows the care management nurse the ability to use all facets of care management to reduce repetitive care and readmissions, thus improving health care outcomes and promoting quality initiatives.

The integrated platform allows the UM module to communicate with the CM module in real time. Automatic transition notifications are routed to CM from UM once a qualifying request is processed in the UM module. This functionality helps drive adherence to regulatory requirements due to the timeliness of the notifications and allows the CM to engage quickly to provide a smooth, effective and efficient transition for the member.

Customers use this solution to:

  • Identify and stratify populations into low-, medium-, and high-risk for referral to Disease Management as part of complex Care Management or as a distinct Disease Management program
  • Trigger various intervention plans based on member risk, including prevention and wellness, health education, disease management, and complex case management
  • Conduct assessments, create individualized care plans, and manage cases using interdisciplinary care teams
  • Evaluate member population for referral to an applicable level of care management based on individual member needs

Have You Considered …

With the Care Gaps solution, you may also want to manage related functionalities on one platform to ensure compliance, improve efficiency and productivity, and deliver better quality care. Consider adding these MedHOK solutions:

Care Management
Star Quality Measures


Meets NCQA, CMS Model of Care, and state regulatory requirements


Industry best practices are built-in, including several assessments such as Program Criteria Survey, PHQ9, Pediatric Health Risk Assessment, Burns Depression Checklist, and many more


Health education materials are generated and automatically delivered based on the risk level assigned to a member

Request a Demo

See How Industry-Leading Payers Use MedHOK’s Care Management Solution

Please complete the form and let us know which capabilities you would like to see. One of our demo specialists will contact you to schedule your custom demo.

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