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MedHOK’s Care Gaps Solution

Care Gaps Solution

Solution Overview

MedHOK’s Care Gaps Management helps health plans excel in a value-based world. The Care Gaps solution supports drug and medical clinical measures, survey measures, and administrative measures to help plans remediate care gaps and improve member satisfaction in all lines of business. Ultimately, this results in better population management and positions plans for higher quality ratings and corresponding reimbursements.

MedHOK provides unparalleled opportunities to analyze, monitor and remediate care gaps throughout the year, thereby reducing year-end fire drills associated with quality measure performance. Features include:

  • Real-time integration of claims and encounter data
  • 360Member® – A 360 degree view of the member, complete with individual care gap and clinical profiles
  • Gaps in care can be monitored daily so that an organization can continuously track its performance and target gap closure and remediation efforts via workflow and correspondence outreach efforts
  • Run clinical campaigns for specific measures by line of business
  • Real-time tracking, target-setting and analysis of measures through a dashboard and comprehensive reporting by multiple lines of business to improve overall HEDIS® results from year to year
  • Out-of-the-box algorithms for quality improvement include:
  1. NCQA certified HEDIS®
  2. NCQA certified Pay for Performance
  3. NCQA certified Disease Management performance measures
  4. CMS Part C and D Star
  5. Pharmacy Quality Alliance drug measures
  6. National and state-specific Medicaid measures
  8. CMS Accountable Care Organization
  9. Client-specific measures configurable through MedHOK configuration tool

Customers use this solution to:

  • quality outcomes by addressing quality initiatives through strong care management processes
  • Improve healthcare initiatives using automated structured workflows and functions to manage member care
  • Improve population health management by stratifying at-risk populations and defining and executing programs to effectively manage their care
  • Improve quality ratings and, therefore, revenue coming to plans or at-risk provider groups.

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


MedHOK has enabled 50 of the largest and highest rated health plans to successfully pass HEDIS®, CMS and State audits


Utilize the most comprehensive evidence-based risk adjustment platform to stratify populations and drive effective care management improvements


MedHOK holds three NCQA® certifications: HEDIS®, Pay for Performance and Disease Management, and has fully integrated Pharmacy Quality Alliance (PQA) drug measures.

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See How the Industry’s Largest Health Plans Use MedHOK’s Care Gaps 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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