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Software Platform

Take control and succeed in value-based healthcare.

MedHOK’s pioneering software platform allows you to manage Risk, Care, and Quality.

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A single, integrated solution.

MedHOK, Inc. (Medical House Of Knowledge) is a SaaS-based compliance platform enabling workflow across risk, care and quality management for government-sponsored health programs and other risk-bearing entities. Our comprehensive, fully-integrated software platform manages member risk and quality of care within an increasingly complex and strenuous regulatory environment. MedHOK was built to address the existing and emerging pain points in today’s healthcare as it moves to a system in which quality of outcomes will determine revenue across the healthcare continuum.

MedHOK’s modular platform leverages a single code base and is delivered out-of-the-box with Medicare, Medicaid, and Affordable Care Act regulatory best practices, and allows for user-configurable workflow and business rules. By breaking down the silos typically associated with member care and expense management, MedHOK’s software platform is the only software that manages members’ pharmacy and medical care on a single platform.

MedHOK provides a unique, one-of-a-kind marriage of medical claims, pharmacy, and lab data, allowing payers to identify and target member health risks, intelligently trigger workflow interventions, improve quality of care, and positively impact revenue—and do so from a single platform. MedHOK aggregates data from a payer’s many disparate sources, applies algorithms to cleanse and normalize data, and feeds into an end-to-end SaaS-based platform, creating a true, enterprise-wide surveillance platform, allowing for real-time data-driven management and a 360° view of the member.

Referred to as 360Member within the MedHOK software platform, 360Member provides an intuitive end-to-end history of each member. Every interaction, including prior authorization (processed by the health plan, provider or delegated entity), appeals, grievances, complaints, over-the-counter medication, clinical surveys, notes, correspondence, etc. are retained at the member level for easy retrieval and audits. Data inputs can be leveraged into member-specific diagnostic profiles with an emphasis on gaps in care, quality, and Hierarchical Condition Category (HCC)/risk adjustment data. This member-centric approach shifts the focus from simply reporting quality measures to actually influencing results for a targeted population.

The MedHOK platform has broad reach and modular functionality with the distinct ability to manage both medical and pharmacy care. Each module is highly configurable to the specific needs of each customer and purpose-built to drive improved clinical outcomes and increased compliance. Explore the platform through the areas of Risk, Care, and Quality for enterprise-wide management of the healthcare continuum.

Risk Management

Risk Management

Compliant Member Enrollment and Data Capture

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

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Care Management

Care Management

Care Coordination & Clinical Outcomes

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

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Quality Management

Quality Management

Monitor, Track, and Improve Quality Performance

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

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Compliance First

MedHOK delivers a comprehensive solution that removes the burden of compliance, driving immediate compliance benefits and creating an audit trail. The MedHOK platform comes pre-configured with state and federal regulations, structured workflows, and analytics across all modules, creating an end-to-end compliance platform that ensures consistent and timely enterprise-wide compliance.

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Our Technology

MedHOK’s SaaS-based platform leverages a single code base in its modules, allowing for a seamless end-to-end solution for healthcare payers. Our Service-Oriented Architecture (SOA) provides the ease-of-integration and interoperability that enables the secure exchange of health information.

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Why MedHOK?

The Right Solution at the Right Time

Fill out the form to download our Fact Sheet, “How MedHOK enables Health Plans and other risk-bearing entities to succeed under value-based programs.”

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