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Pay for Quality

Tying Revenue to Quality

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 Pay for Quality components 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 the bottom line


Manage and close care gaps throughout the year to drive continued quality improvements.


Realize full visibility across all levels of the organization, including lines of business, departments, members, and providers


Real-time data from continuum of care applications drive seamless quality management

Pay for Quality

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

Click each heading below to learn more about the Pay for Quality components of the MedHOK Unified Payer Platform.


Compliance and Quality Take Center Stage

Efforts to transform to a value-driven healthcare system are well under way with the Centers for Medicare and Medicaid Services (CMS) leading the charge. As a result of healthcare reform, health plans and all risk-bearing entities will continue to experience the compounding impact of compliance as quality and risk requirements expand the definition of compliance and quality.

This webinar, presented by MedHOK’s Chief Strategy and Compliance Officer, Marc S. Ryan, will provide an overview of the latest changes with regard to compliance, audit, and quality in the Medicare Advantage program.

Webinar Registration

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