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Quality

Ensure Premium Quality To Drive Revenue Realization

Quality is at the center of value-based healthcare. The member is at the center of quality. Quality programs must be member-centric and built around regulatory guidance and requirements. Healthcare organizations that are based on a systems infrastructure that is still oriented to the vertically-oriented legacy claims processing fee-for-service model are struggling to make this transformation. Quality is measured in terms of outcomes which shift service focus and measures to a horizontally oriented continuum of care focus. Healthcare organizations need a powerful unified system to make this transition.

Many healthcare oganizations are trying to bake the value-based healthcare and compliance pie, one piece at a time. Addressing individual components of the complex health plan service delivery model, these healthcare organizations end up with multiple disparate systems that lack integration and cohesive, meaningful and actionable data. To make the transformation to value-based healthcare, healthcare organizations need to bake the whole pie and consume it one piece at a time.

MedHOK’s Unified Payer Platform provides full range of quality solutions that enable member-centered premium quality care, compliance adherence and quality measurement. MedHOK quality solution include HEDIS®, Star Quality Measures, Care Gaps, Risk Adjustment and Data Validation, Process Improvement/Root Cause analysis and others. Providing automated structured workflows fully integrated between solutions components, MedHOK enables a unified approach to ensuring quality, compliance and value delivery. MedHOK’s Unified Payer Platform provides everything you need to succeed in value-based healthcare and compliance. It’s all right here.

HEDIS® AND HYBRID QUALITY MEASURES

Comprehensive HEDIS® solution fully integrated with structured workflow applications ensuring real-time compliance adherence.

STAR QUALITY MEASURES

The #1 Rated Health Plan in the U.S. Uses MedHOK’s Unified Payer Platform.

CARE GAPS

Identify and remediate gaps in care to drive improved quality ratings and revenue realization.

Quality Components

MedHOK delivers a broad range of quality modules that improve compliance, operational efficiency, revenue realization, quality outcomes and enable the transformation to value-based healthcare.

Learn more about the Quality components in MedHOK’s Unified Payer Platform by clicking the titles below.

Webinar

Focus on the Member: The Premise for Value-Based Healthcare

Value-based healthcare requires a focus on the Member — quite a shift from the provider-centric, transaction-focused models Payers are familiar with. This paper discusses how a focus on the Member will result in better quality, care, and outcomes.

Fill out the form to the right to download the paper now.

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