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New Quality

Focus on Member Experience

Monitor, track, and improve quality performance by creating an ecosystem of best practices

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Improve Quality Scores and Improve Revenue

In order to compete in a post-reform world, government- sponsored plans are faced with the dual requirements of managing costs and revenue in an integrated manner. Government-funded plans must be more focused on the health acuity of their members in order to maximize revenue on the population they manage. Quality has become a financial imperative as more dollars are tied to quality initiatives such as HEDIS and Star programs. Risk-based models have moved beyond Medicare and into Medicaid and public exchanges, providing additional complexity amid accelerating growth in risk-based plans. However, legacy systems were not built for this shift to value-based healthcare.

MedHOK’s Quality Management modules form an end-to-end solution to meet all of the quality performance mandates, including year-round tracking of HEDIS, Star, Medicare Part C and D, Medicaid and other care gaps and quality measures. MedHOK empowers plans and providers to track quality performance throughout the year and run remediation campaigns to improve quality performance and revenue, thereby improving revenue.

“Quality measures today require a system that ensures 100% compliance, integrates care, and proves a positive member experience.”

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