skip to Main Content


Enterprise Software Platform for Managing Risk, Care, and Quality

Compliant Today … Sleep Well Tonight

Healthcare compliance isn’t just a department — it’s a way of business. If one area of your business is out of compliance, no one sleeps until it’s resolved.

Because of healthcare reform, health plans and all risk-bearing entities will continue to experience the compounding impact of compliance as care and risk requirements expand the definition of compliance and quality.

Risk Management

Risk Management

Compliant Member Enrollment and Data Capture

  • Sales & Marketing
  • Enrollment & Operations
  • Risk Adjustment
  • Grievances and Complaints
  • Regulatory Tracking

Learn More

Care Management

Care Management

Care Coordination & Clinical Outcomes

  • Case and Disease Management
  • Medication Therapy Management
  • Medical and Pharmacy Appeals
  • Utilization Management

Learn More

Quality Management

Quality Management

Monitor, Track, and Improve Quality Performance

  • Star
  • Pay for Performance (P4P)
  • Care Gaps

Learn More

Our Users

The MedHOK Software Platform enables Health Plans and other risk-bearing entities to manage Risk, Care, and Quality across the enterprise.

Health Plan success requires sophisticated analytics and quality capabilities to maximize member satisfaction and regulatory compliance. MedHOK’s data aggregation and normalization capabilities allow Health Plans to build comprehensive 360° member profiles to enable the most impactful member interventions. Learn More

ACOs and other provider groups caring for Medicare patients require a system to ensure that they provide coordinated, integrated care, meet quality metrics and regulations, and reduce costs. MedHOK delivers a quality and analytical infrastructure with built-in compliance and workflow management that improves outcomes across the continuum of care, while achieving savings. Learn More

It’s important for Specialty Pharmacies to comprehensively manage patient programs to drive medication adherence and deliver better outcomes. Specialty Pharmacies rely on MedHOK to conduct all order management, benefit management, fulfillment, and care management in one system, thereby reducing costs and improving member satisfaction. Learn More

PBMs benefit from MedHOK’s ability to ensure compliance with state and federal regulations and help meet service level agreements (SLAs) with payers. MedHOK’s software platform empowers PBMs to deliver services that deliver better outcomes. Learn More


Succeeding in a Post-Reform Healthcare World

Historically, health plans focused medical management activities around utilization management and condition-specific disease management programs. New Medicare dictates require health plans to become more focused on quality and the acuity of their members in order to maximize revenue. But with many disparate systems, legacy systems, lack of IT resources, and overall lack of transparency and clarity within the organization, managing a healthcare business successfully in this new healthcare model has become complicated. In order to compete in a post-reform world, risk-bearing entities will be faced with the dual requirements of managing costs and revenue in an integrated manner. MedHOK unravels the complexities of this new world and offers steps to ensure success with value-based healthcare.

From the Blog

CARA Act Implementation Gives Medicare Plans Additional Opportunities to Impact Drug Abuse

In early March, the Centers for Medicare and Medicaid Services (CMS) announced its final rule related to policy changes for Medicare Advantage and Part D plans in 2019. One key point in the rule was implementation of aspects of the Comprehensive Addiction and Recovery Act of 2016 (CARA). The final rule’s CARA provision seeks to provide an additional tool to help Medicare Advantage (MA) and standalone Part D plans (PDP) to combat the growing opioid epidemic in America.The 2016 act required CMS…Read more

Subscribe to Email Updates

Back To Top