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Unified Payer Platform

Health plans and payer organizations have built their information systems to support a transaction-oriented, fee-for-service model, with the provider at the crux. Value-based healthcare turns this model on its side, putting the focus on the member, with quality measures driving reimbursements and revenue. Many disparate legacy systems on which payers rely, hinder the ability to have a centralized view of the member and assess compliance adherence in real time.

The best way to succeed in the healthcare payer transformation while adhering to rigorous compliance demands is with a single solution that consolidates continuum of care applications into a single repository, and utilizes all information to automate and enable workflows based on best practices.

Frustrated with single, department-by-department solutions, healthcare payers are turning to a Unified Payer Platform that can manage the entire continuum of care across Medicare, Medicaid, Commercial, and Exchange lines of business to enable and automate workflows, improve productivity, increase organizational transparency, and facilitate compliance.

MedHOK is the industry’s first and only Unified Payer Platform that unifies and makes actionable members’ medical and pharmacy history, appeals and grievances, enrollment data, interventions, claims, communications, and every interaction with the plan, provider, or business partner into one system that spans the entire enterprise.

MedHOK’s Solutions

MedHOK’s Unified Payer Platform aligns the entire organization, simplifies systems and processes, unifies data into actionable ecosystems that enable workflows, and ensures compliance. Built from the ground up to be 100% out-of-the-box compliant with Medicare, Medicaid, Commercial and Exchange, MedHOK’s Unified Payer Platform is also proactively updated with new compliance rules and regulations through seamless pushes to the cloud, ensuring perennial compliance.

In one platform, MedHOK delivers everything you need to succeed with value-based healthcare:

  1. Medical and Pharmacy Care – unifies utilization, care and disease management, appeals and grievances, MTM, pharmacy prior authorization and more
  2. Member Engagement – captures all member data and communications from enrollment and member services to complaints and compliance tracking
  3. Pay-for-Quality – connects member care to quality and compliance measures, such as HEDIS and Stars, supercharging member care and revenue realization
  4. Stakeholder Collaboration – promotes engagement with provider and business partner stakeholders, building communities and extending oversight

A shift from a provider-centric, fee-for-service model to one based on quality requires a unified system that aligns member care to quality measures


Only a single platform solution with real-time access to all member care and quality can meet the rigorous compliance demands of value-based healthcare


Integrated continuum of care applications with structured workflows and an intuitive user interface supercharges your organization’s productivity

White Paper

A Recipe for Value-Based Healthcare Success

Value-based healthcare is a major change in the way healthcare payers have traditionally managed their members. What’s the best way to approach this new payment model that focuses on the care and quality of the member? This paper discusses the basis for value-based healthcare and what every payer needs to consider to succeed

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